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Canadian  Institute  for  Historical  Microraproductions  /  Institut  Canadian  da  microraproductions  historiquas 


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The  copy  film«d  h«r«  has  b««n  reproduced  thanks 
to  tha  ganarosity  of: 

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or  ic.ustratad  impresoion. 


The  laat  recorded  frame  on  eech  microfiche 
shall  contain  tha  symbol  —»'  (meaning  "CQN- 
TINUED").  or  the  symbol  V  (meaning  "END  "). 
whichever  applies. 

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right  and  top  to  bottom,  as  many  frames  as 
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method: 


L'axamplaira  film*  fut  reproduit  grice  A  la 
g*n4rosit*  da: 

Academy  of  Medicine  Collection 
The  Toronto  Hospital 

Las  Imagas  suivantas  ont  M  raproduitas  avac  la 
plus  grand  soin,  compta  tanu  da  la  condition  et 
da  la  nattetA  da  I'axemplaira  film*,  at  an 
conformity  avec  lea  conditions  du  contrat  da 
fllmage. 

Lea  exempiairea  originaux  dont  la  couvarture  an 
papier  est  imprimte  sont  fiimis  an  commandant 
par  la  premier  plat  at  an  tarminant  soit  par  la 
darniire  page  qui  comporta  une  ampreinta 
d'impraasion  ou  d'illustration,  soit  par  la  second 
plat,  sslott  le  eas.  Tous  las  autras  axamplairas 
originaux  sont  filmte  an  commanpant  par  la 
pramiire  page  qui  comporta  une  empreinte 
d'impreasion  ou  d'illustration  at  an  tarminant  par 
la  darniire  page  qui  comporta  una  telle 
empreinte. 

Un  des  symboles  suivants  apparaitra  sur  la 
darniire  image  de  cheque  microfiche,  salon  la 
cas:  la  symbola  —^  signifie  "A  SUIVRE",  le 
symbols  ▼  signifie  "FIN". 

Les  cartaa.  planchea.  tableaux,  etc..  pauvant  itra 
filmis  i  des  taux  de  reduction  diffirents. 
Lorsque  le  document  est  trop  grand  pour  itra 
reproduit  en  un  seul  clichi.  il  est  f  ilmi  i  partir 
da  Tangle  supirieur  gauche,  de  gauche  i  droite, 
at  de  haut  an  bas.  an  pranant  la  nombra 
d'images  nicessaire.  Las  diagrammes  suivants 
illustrant  la  mithoda. 


1  2  3 


1  2  3 

4  5  6 


1.0 


I.I 


1.25 


28 


1^    1^ 

If      1^ 


1.4 


2.5 

12.2 

2.0 
1.8 

1.6 


MICROCC  'Y  RESOLUTION  TEST  CHART 

NATIONAL  BUREAU  OF  STANDARDS 

STANDARD  REFERENCE  MATERIAL  1010a 

(ANSI  and  ISO  TEST  CHART  No.  2) 


AEQUANIMITAS 


4 


AEQUANIMITAS 

With  other  Addresses  to  Medical 
Students,  Nurses  and  Prac- 
titioners of   Medicine 


I 


By 
WILLIAM     OSLER,    M.D.,    F.R.S 

Professor  of  AUdimi,  John,  Ihpktm  Univmity,  Em'imor, 


P.  BLAKISTON'S  SON  &  CO 

PHILADELPHIA 

1904 


To 
D^^NIEL  C.  OILMAN. 

EX-PBMIDEJfT  OF  TH.     •  ^HKS  HOVK  Jf9  UuiVSBSnT. 

DxAB  Db.  Gilman, 

Please  accept  the  dedication  of  this  volume  of  addressee, 
in  memory  of  those  happy  days  in  1889  when,  under  your  guidance, 
the  Johns  Hopkins  Hospital  was  organized  and  opened;  and  in 
grateful  recognition  of  your  active  and  intelUgent  interest  in  medical 

education. 

Youra  sincerely, 

William  OsLEB. 


\-\'&' 


CONTENTS 

(xur.  fkom 

L    AsqiTAinHiTAS 1 

n     DOCTOB  AND  XxrBSX 13 

ni    Teacher  and  Sttobnt 21 

IV    Physic  and  Physicians  as  Depicted  in  Plato  .        .  45 

V    The  Leaven  of  SaENCE 77 

VI  The  Abhy  Surgeon 103 

VII  Teaching  and  Thinkino 121 

VIII    Internal  Medicine  as  a  Vocation    ....  137 

IX    NuESE  AND  Patient 153 

X    Beitish  Medicine  in  Greater  BanAiN    .        .        .167 

XI    Afier  Twenty-Five  Years 197 

Xn    Books  and  Men 217 

XIII  Medicine  in  the  Nineteenth  Centcey      .        .        .  227 

XIV  Chauvinism  in  Medicine 277 

XV    Some  Aspects  of  A3iEEici.v  Medical  Bibliogbafhy  .  307 

XVI    The  Hospital  as  a  College 327 

XVII    On  the  Educational  Value  of  the  Medical  Society  343 

XVJLu    The  I^Iastib-Wobd  in  Medicine  .        .        .        .363 

vii 


iHHMa 


AEQUANIMITAS 


AB. 


Thou  must  be  Uke  a  promontory  of  the  sea,  agamst  which,  though 

the  waves  beat  continuaUy.  yet  it  both  itself  stands,  and  about  it 

are  thoee  awelling  waves  stilled  and  quieted. 

Mabcus  Aubeltos. 

I  say :  Fear  not !    Life  still 
lieaves  human  effort  scope. 
But,  since  life  teems  with  ill. 
Nurse  no  extravagant  hope  ; 
Because  thou  must  not  dream,  thou  need'st  not  then  despair! 

Matthew  Abnold,  Empedoclea  on  Etna. 


\ 


i 


AEQUANIMITAS' 


TO  many  the  frost  of  custom  has  made  even  these  im- 
posing annual  ceremonies  cold  and  lifeless.  To  you, 
at  least  oi  those  present,  they  should  have  the  solemnity  of 
an  ordinance — called  as  you  are  this  day  to  a  high  dignity 
and  to  so  weighty  an  oflSce  and  charge.  You  have  chosen 
your  Geniufi,  have  passed  beneath  the  Throne  of  Necessity, 
and  with  the  voices  ^f  the  fatal  sisteris  still  in  your  ears, 
will  soon  en!;er  the  plain  of  Forgetfulness  and  drink  of  the 
waters  of  its  river.  Ere  you  are  driven  all  manner  of 
ways,  like  the  souls  in  the  tale  of  Er  the  Pamphylian,*  it  is 
my  duty  to  say  a  few  words  of  encouragement  and  to  bid 
you,  in  the  name  of  the  Faculty,  God-speed  on  your  jourrc^y. 

I  could  have  the  heart  to  spare  you,  poor,  careworn 
survivors  of  a  hard  struggle,  so  "  lean  and  pale  and  leaden- 
eye  "  with  study ; "  and  my  tender  mercy  constrains  me 
to  consider  but  two  of  the  score  of  elements  which  may 
make  or  mar  your  lives — which  may  contri  te  to  your 
luxess,  or  help  you  in  the  days  of  failure. 

In  the  first  p'aoe,  in  the  physician  or  surgeon  no  quality 
takes  rank  with  imperturbability,  and  I  propose  for  a  few 
minutes  to  direct  your  attention  to  this  essential  bodily 
virtue.    Perhaps  I  may  be  able  to  give  those  of  you,  in 

1  Valedictory  Address,  University  of  Pennsylvania,  May  1, 1880 
*  The  Bepublic,  Book  X. 

8 


AEQUANIMITAS 

whom  it  has  not  developed  during  the  ciiticftl  scene:;  oi  the 
put  moiith,  a  hint  or  two  of  its  importance,  possibly  a 
suggestion  for  its  attainment.  Imperturbability  aieans 
coolness  and  presence  of  mind  under  all  circumstances, 
calmness  amid  storm,  clearness  of  judgment  in  moments 
of  grave  peril,  immobility,  impassiveness,  or,  to  use  an  old 
and  expressive  word,  phlegm.  It  is  the  quaUty  which  is 
most  appreciated  by  the  laity  though  often  misunderstood 
by  tnem ;  and  the  physician  who  has  the  misfortune  to  be 
without  it,  who  betrays  indecision  and  worry,  and  who 
shows  that  he  is  flustered  and  flurried  in  ordinary  emer- 
gencies, loses  rapidly  the  confidence  of  his  patients. 

In  full  levelopment,  as  we  see  it  in  some  of  our  older 
colleagues,  it  has  the  nature  of  a  divine  gift,  a  blessing  to 
the  possessor,  a  comfort  to  all  who  come  in  contact  with 
him.    You  should  know  it  well,  for  there  have  been  before 
you  for  years  several  striking  illustrations,  whose  example 
has,  I  trust,  made  a  deep  impression.    As  imperturbability 
is  largely  a  bodily  endowment,  I  regret  to  say  that  there 
are  those  amongst  you,  who,  owing  to  congenital  defects, 
may  never  be  able  to  acquire  it.    Education,  however, 
wUldo  much;   and  with  practice  and  experience  the 
majority  of  you  may  expect  to  attain  to  a  fair  measure. 
The  first  essential  is  to  have  your  nerves  well  in  hand. 
Even  under  the  most  serious  circumstances,  the  physician 
or  surgeon  who  allows  "  his  outward  action  to  demon- 
strate the  native  act  and  figure  of  his  heart  in  complement 
extern,"  who  shows  in  his  fac3  the  slightest  alteration, 
expressive  of  anxiety  or  fear,  has  not  his  medullary  centres 
under  the  highest  control,  and  is  liable  to  disaster  at  any 

moment.    I  have  spoken  of  this  to  you  on  many  occasions, 

4 


AEQUANIMITAS 

and  have  urged  you  to  educav^e  your  nerve  centres  so  that 
not  the  slightest  dilator  or  contractor  influence  shall  pass  to 
the  vesseb  of  your  face  under  any  professional  trial.  Far 
be  it  from  me  to  urge  you,  ere  Time  has  carved  with  his 
hours  those  fair  brows,  to  quench  on  all  occasions  the 
blushes  of  ingenuous  shame,  but  in  dealing  with  your 
patients  emergencies  demanding  these  should  certainly 
not  arise,  and  at  other  times  an  inscrutable  face  may  prove 
a  fortune.  In  a  true  and  perfect  form,  imperturbability 
is  indissolubiy  associated  with  wide  experience  and  an 
intimate  knowledge  of  the  varied  aspects  of  disease.  With 
such  advantages  he  is  so  equipped  that  no  eventuality 
can  disturb  the  mental  equilibrium  of  the  physician ;  the 
possibilities  are  always  manifest,  and  the  course  of  action 
clear.  From  its  very  nature  this  precious  quality  is  liable  to 
be  misinterpreted,  and  the  general  accusation  of  hardness, 
so  often  brought  against  the  pioiession,  has  here  its  founda- 
tion. Now  a  certain  measure  of  insensibility  is  not  only 
an  advantage,  but  a  positive  necessity  in  the  exercise  of  a 
calm  judgment,  and  in  carrying  out  delicate  operations. 
Keen  sensibility  is  doubtless  a  virtue  of  high  order,  when 
it  does  not  interfere  with  steadiness  of  hand  or  coolness  of 
nerve ;  but  for  the  practitioner  in  his  woiking-day  world, 
a  callousness  which  thinks  only  of  the  good  to  be  effected, 
and  goes  ahead  regardless  of  smaller  considerations,  is  the 
preferable  quality. 

Cultivate,  then,  gentlemen,  such  a  judicious  measure 
of  obtuseness  as  will  enable  you  to  meet  the  exigencies  of 
practice  with  firmness  and  courage,  without,  at  the  same 
time,  hardening  "  the  human  heart  by  which  we  live." 

In  the  second  place,  there  is  a  mental  equivalent  to  this 

5 


i'i 


AEQUANIMITAS 

bodUy  endo'nxient,  which  is  as  important  in  our  pUgrimage 
as  imperturbabiUty.    Let  me  recall  to  your  minds  an 
incident  related  of  that  best  of  men  and  wisest  of  rulers, 
Antoninus  Pius,  who,  as  he  lay  dying,  in  his  home  at  Lonum 
in  Etruria,  summed  up  the  philosophy  of  life  in  the  watch- 
word, AeqmnimUas.  As  for  him,  about  to  pass  flammaraia 
moenia  mundi  (the  flaming  rampart  of  the  world),  so  for 
you,  fresh  from  Qotho's  spindle,  a  calm  equanmuty  is  the 
desiable   attitude.    How   difficult  to  attain,   yet  how 
necessary,  in  success  as  in  faUure!    Natural  tempera- 
ment has  much  to  do  with  its  development,  but  a  clear 
knowledge  of  our  relation  to  our  fellow-creatures  and  to 
the  work  of  Ufe  is  also  indispensable.    One  of  the  first 
essentials  in  securing  a  good-natured  equanimity  is  not  to 
expect  too  much  of  the  people  amongst  whom  you  dwell. 
"  Knowledge  comes,  but  wisdom  lingers,"  and  m  matters 
medical  the  ordinary  citizen  of  to-day  has  not  one  whit 
more  sense  than  the  old  Romans,  whom  Lucian  scourged 
for  a  credulity  which  made  them  fall  easy  victims  to  the 
quacks  of  the  time,  such  as  the  notorious  Alexander,  whose 
exploits  make  one  wish  that  his  advent  bar!  been  delayed 
some  eighteen  centuries.    Deal  gently  then  with  this  de- 
liciously  credulous  old  human  nature  in  which  we  work, 
and  restrain  your  indignation,  when  you  find  your  pet 
parson  has  triturates  of  the  1000th  potentiality  in  his 
waistcoat  pocket,  or  you  discover  accidentally  a  case  of 
Warner's  Safe  Cure  in  the  bedroom  of  your  best  patient. 
It  must  needs  be  that  offences  of  this  kind  come ;  expect 
them,  and  do  not  be  vexed. 

Curious,  odd  compounds  are  these  fellow-creatures,  at 
whose  mercy  you  will  be ;  full  of  fads  and  eccentricities, 

6 


AEQUAN1M1TA8 

of  whims  and  fancies ;  but  the  moro  closely  we  study  their 
little  foibles  of  one  sort  and  another  in  the  inner  life  which 
we  see,  the  more  surely  is  the  conviction  borne  in  upon  us 
of  the  likeness  of  their  weaknesses  to  our  own.   The  simi- 
larity would  be  intolerable,  if  a  happy  egotism  did  not  often 
render  us  forgetful  of  it.    Hence  the  need  of  an  infinite 
patience  and  of  an  ever-tender  charity  toward  these  fellow- 
creatur«)8  ;  have  they  not  to  exercise  the  same  toward  us  ? 
A  distressing  feature  in  the  life  which  you  are  about  to 
enter,  a  feature  which  will  press  hardly  upon  the  finer 
spirits  among  you  and  ruffle  their  equanimity,  is  the  un- 
certainty which  pertains  not  alone  to  our  science  and  art, 
but  to  the  very  hopes  and  fears  which  make  us  men.    In 
seeking  absolute  truth  we  aim  at  the  imattainable,  and 
must  be  content  with  finding  broken  portions.    You  re- 
member in  the  Egyptian  story,  how  Typhon  with  his  con- 
spirators dealt  with  good  Osiris  ;  how  they  took  the  virgin 
Truth,  hewed  her  lovely  form  into  a  thousand  pieces,  ard 
scattered  them  to  the  four  winds;  and,  as  Milton  says, 
"  from  that  time  ever  since,  the  sad  friends  of  truth,  such 
as  durst  appear,  imitating  the  careful  search  that  Isis 
made  for  the  mangled  body  of  Osiris,  went  up  and  down 
gathering  up  limb  by  limb  still  as  they  could  find  them. 
We  have  not  yet  found  them  all,"  '  but  each  one  of  us  may 
pick  up  a  fragment,  perhaps  two,  and  in  moments  when 
mortality  weighs  less  heavily  upon  the  spirit,  we  can,  as 
in  a  vision,  see  the  form  divine,  just  as  a  great  Naturalist, 
an  Owen  or  a  Leidy,  can  reconstruct  an  ideal  creature 
from  a  fossil  fragment. 


>  Areopagitica. 
7 


AEQUANIMITAS 

It  hM  been  said  that  in  prosperity  onr  equanimity  is 
chiefly  exercised  m  enabling  us  to  bear  with  composure 
the  misfortunes  of  our  neighbours.  Now,  while  nothing 
disturbs  our  mental  placidity  more  sadly  than  straightened 
means,  and  the  lack  of  those  things  after  which  the  Gentiles 
seek,  I  would  warn  you  againsv  the  trials  of  the  day  soon 
to  come  to  some  of  you— the  di>y  of  large  and  successful 
practice.  Engrossed  late  and  soon  in  professional  cares, 
getting  and  spending,  you  may  so  lay  waste  your  powers 
that  you  may  find,  too  late,  with  hearts  given  away,  that 
there  is  no  place  in  your  habit-stricken  souls  for  those 
gentler  influences  which  make  life  worth  living. 

It  is  sad  to  think  that,  for  some  of  you,  there  is  in  store 
disappointment,  perhaps  failure.  You  cannot  hope,  of 
course,  to  escape  from  the  cares  and  anxieties  incident  to 
professional  life.  Stand  up  bravely,  even  against  the 
worst.  Your  very  hopes  may  have  passed  on  out  of  sight, 
as  did  all  that  was  near  and  dear  to  the  Patriarch  at  the 
Jabbok  ford,  and,  like  him,  you  may  be  left  to  struggle 
in  the  night  alone.  Well  for  you,  if  you  wrestle  on,  for  in 
persistency  lies  victory,  and  with  the  morning  may  come 
the  wished-for  blessing.  But  not  always ;  there  is  a  struggle 
with  defeat  which  some  of  you  will  have  to  bear,  and  it 
will  be  well  for  you  in  that  day  to  have  cultivated  a  cheer- 
ful equanimity.  Remember,  too,  that  sometimes  "  from 
our  desolation  only  does  the  better  life  begin."  Even  with 
disaster  ahead  and  ruin  imminent,  it  is  better  to  face  them 
with  a  smile,  and  with  the  head  erect,  than  to  crouch  at 
their  approach.  And,  if  the  fi-^ht  is  for  principle  and 
justice,  even  when  failure  seems  certain,  where  many  have 
failed  before,  cling  to  your  ideal,  and,  like  Childe  Roland 

8 


AEQUANIMITA8 

beioie  the  dark  tower,  set  the  slug-horn  to  yonr  lips, 
blow  the  ohftllenge,  and  calmly  await  the  conflict. 

It  has  been  said  that  "  in  patience  ye  shall  win  your 
souk,"  and  what  is  this  patience  but  an  equanimity  which 
enables  you  to  rise  superior  to  the  trials  of  life  ?  Sowing 
as  you  shall  do  beside  all  waters,  I  can  but  wish  that  you 
may  reap  the  promised  blessing  of  quietness  and  of  assur- 
ance forever,  until 

Within  this  life, 

Though  lifted  o'er  ita  strifej 

you  may,  in  the  growing  winters,  glean  a  little  of  that 
wisdom  which  is  pure,  peaceable,  gentle,  full  of  mercy  and 
good  *niits,  without  partiality  and  without  hypocrisy. 

The  past  is  always  with  us,  never  to  be  escaped;  it 
alone  is  enduring ;  but,  amidst  the  changes  and  chances 
which  succeed  one  another  so  rapidly  in  this  life,  we  are 
apt  to  live  too  much  for  the  present  and  too  much  in  the 
future.  On  such  an  occasion  as  the  present,  when  the 
Alma  Mater  b  in  festal  array,  when  we  joy  in  her  growing 
prosperity,  it  is  good  to  hark  back  to  the  olden  days  and 
gratefully  to  recall  the  men  whose  labours  in  the  past 
have  made  the  present  possible 

The  great  possession  of  any  Uni\  is  lz  its  great  names. 
It  is  not  the  "  pride,  pomp  and  circumstance  "  of  an  insti- 
tution which  bring  honour,  not  its  wealth,  nor  the  number 
of  its  schools,  not  the  students  who  throng  its  halls,  bus 
the  men  who  have  trodden  in  its  service  the  thorny  road 
through  toil,  even  through  hate,  to  the  serene  abode  of 
Fame,  climbing  "like  stars  to  their  appointed  height." 
These  bring  glory,  and  it  should  thrill  the  heart  of  every 
alumnus  of  this  school,  of  every  teacher  in  its  faculty, 

9 


\{  1 


AEQUANIMITAS 
M  it  does  mine  this  d«y,  reverently  and  thankfully  to 
recall  such  names  amongst  its  founders  as  Morgan,  Shippen, 
and  Rv.h,  and  such  men  amongst  their  successors  as 
Wistar,  Physick,  Barton,  and  Wood. 
Gentlemen  of  the  Faculty— ^oWe*«e  oblige. 
And  the  sad  reality  of  the  past  teaches  us  to-day  in  the 
freshness  of  sorrow  at  the  loss  of  friends  and  colleagues, 
'•  hid  in  death's  dateless  night."    We  miss  from  our  midst 
one  of  your  best  known  instructors,  by  whose  lessons  you 
have  profited,  and  whose  example  has  stimulated  many. 
An  earnest  teacher,  a  faithful  worker,  a  loyal  son  of  this 
University,  a  good    and   kindly  friend,  Edward    Bruen 
has  left  behind  him,  amid  regrets  at  a  career  untimely 
closed,  the  memory  of  a  well-spent  life. 

We  mourn  to-day,  abo,  with  our  sister  college,  the 
grievous  loss  which  she  has  sustained  in  the  death  of  one 
of  her  most  distinguished  teachers,  a  man  who  bore  with 
honour  an  honoured  name,  and  who  added  lustre  t^  the 
profession  of  this  city.  Such  men  as  Samuel  W.  Gross 
can  ill  be  spared.  Let  us  be  thankful  for  the  example 
of  a  courage  which  could  fight  and  win ;  and  let  us  emulate 
the  zeal,  energy,  and  industry  which  characterized  his 
career. 

Personally  I  mourn  the  loss  of  a  preceptor,  dear  to  me 
as  a  father,  the  man  from  whom  more  than  any  other  I 
received  inspiration,  and  to  whose  example  and  precept 
I  owe  the  position  which  enables  me  to  address  you  to- 
day. There  are  those  present  who  will  feel  it  no  exag- 
geration when  I  say  that  to  have  known  Palmer  Howard 
was,  in  the  deepest  and  truest  sense  of  the  phrase,  a  Uberal 

education — 

10 


AEQUANIMITAS 

Whftterer  w»y  my  dayt  decline. 

I  felt  and  feel,  tho'  left  alone, 

HU  being  working  in  mine  own^ 
The  footstep*  of  hia  life  in  mine. 

While  preaching  to  you  a  doctrine  of  equanimity,  I  am, 
myself;  a  castaway.    Recking  not  my  own  rede,  I  illustrate 
the  inconsistency  which  so  readily  besets  u  .    One  might 
have  thought  that  in  the  premier  school  of  America,  in 
this  Civitas  Hippocratica,  with  associations  so  dear  to  a 
lover  of  his  profession,  with  colleagues  so  distincuished, 
and  with  students  so  considerate,  one  might  have  '.lought, 
I  say,  that  the  Hercules  Pillars  of  a  man's  ambition  had 
here  been  reached.    But  it  has  not  been  so  ordained,  and 
to-day  I  sever  my  connexion  with  this  University.    More 
than  once,  gentlemen,  in  a  life  lich  in  the  priceless  blessings 
of  friends,  I  have  been  placed  in  positions  in  which  no 
word-,  could  express  the  feelings  of  my  heart,  and  so  it  is 
with  me  now.    The  keenest  sentiments  of  gratitude  well 
up  from  my  innermost  being  at  the  thought  of  the  kind- 
liness and  goodness  which  have  fohowed  me  at  every  step 
during  the  past  five  years.    A  stranger— I  cannot  say  an 
alien— among  you,  I  have  been  made  to  feel  at  home- 
more  you  could  not  have  done.    Could  I  say  more  1 
Whatever  the  future  may  have  in  store  of  success  or  of 
trials,  nothing  can  blot  the  memory  of  the  happy  days 
I  have  spent  in  this  city,  and  nothing  can  quench  the  pride 
I  shall  always  feel  at  having  been  associated,  even  for  a 
time,  with  a  Faculty  so  notable  in  the  past,  so  distinguished 
in  the  preser  i,  as  that  from  which  I  now  part. 

Gentlemen,— Farewell,  and  take  with  you  into  the  struggle 
the  watchword  of  the  good  old  Roman— Aequanimitas. 

11 


I'l  ) 


■- —    -t 


II 

DOCTOR   AND   NURSE 


18 


^?ile.  He  is  the  flower  (such  ^l^^f  ^^^  ^  y^  n^arveUed 
^hen  that  stage  of  man jfl  ^°«  ^'^^;^  .tared  as  little  as  any  m 
It  m  history,  he  wiU  ^^^^^f  ^*^t  notebly  exhibited  the  virtues 

1  defects  of  the  P«'f '  f  ^ J^eJt  is  possible  to  thosejho 

of  the  raoe.    Generosity  be  h^j^«"^h^^  ^  ,^^,  ^  ^J'''°'''^^. 

practise  an  art.  never  *«  *h^«Ji\°i^  ^  thousand  embarrassments . 

Z  a  hundred  secrets ;  t^^*' f  ^^^^i*^  cheerfulness  and  courage. 

2d  what  are  more  im^^ut  H^r^lean  ^  ^^^^  ^^^  ^^^^^  ^^^^^^ 

So  that  he  brings  a^  and  chee^"'  ^^^^^^^ 

"^"^  -^^  ;:::::J^s  s..v..so..  p.iace  t.  r«..«^. 

^^  not  Silence  the  wisdom  0^^^^^,'^^:;::^^.  S^^^ 
tbl^^our  of  wise  Men.  f «  ^-^'Stt  abtdanl.  but  the  weU- 
of  Taciturnity.  ^^^.^  >  Hear^     Such  Silence  may  be  Eloquence. 

weighed  thoughts  of  their  Hearts-    bu 

and  speak  thy  worth  above  the  power  o  ^^^^  ^^^^^^ 


t  ^'  t 


14 


II 

DOCTOR   AND   NURSE* 


THERE  are  individuals— doctors  and  nurses,  for  ex- 
ample— ^whose  very  existence  is  a  constant  reminder 
of  our  frailties ;  and  considering  the  notoriously  irritating 
character  of  such  people,  I  often  wonder  that  the  world 
deals  so  gently  with  them.  The  presence  of  the  parson 
suggests  dim  possibilities,  not  the  grim  realities  conjured 
up  by  the  names  of  the  persons  just  mentioned ;  tue 
lawyer  never  worries  us — in  this  way,  and  we  can  imagine 
in  the  future  a  social  condition  in  which  neither  divinity 
nor  law  shall  have  a  place — when  all  shall  be  friends  and 
each  one  a  priest,  when  the  meek  shall  possess  the  earth ; 
but  we  cannot  picture  a  time  when  Birth  and  Life  and 
Death  shall  be  separated  from  that  "  grizzly  troop  "  which 
we  dread  so  much  and  which  is  ever  associated  in  our  minds 
with  "  physician  and  nurse." 

Dread !  Yes,  but  mercifully  for  us  in  a  vague  and 
misty  way.  Like  schoolboys  we  play  among  the  shadows 
cast  by  the  turrets  of  the  temple  of  oblivion,  towards 
which  we  travel,  regardless  of  what  awaits  us  in  the  vale 
of  years  beneath.  Suffering  and  disease  are  ever  before 
us,  but  life  is  very  pleasant ;  and  the  motto  of  the  world, 
when  well,  is  "  forward  with  the  dance."    Fondly  imagin* 

>  Johns  Hopkins  Hospital,  1891. 
16 


•I, 


DOCTOR  AND  NURSF. 

^ ,    M^ioiMy.  the  tragedy  ^1^*^  «  .^ 

proportion..    A.«l  better  » ;  fo^  ^««      ^^^ 
U  "  a  «  had  a  l*-'--^-^  ^^  po,.  or  the 
hamM.  Ufe,  it  woald  be  lAe  heamg       8      »        ^^^^ 
sqwrrel'.  heart  beat,  and  «e  Aould  die 
Ues  on  the  other  side  of  «le«oe.  ^^^^  ^  ^^  ^, 

With  many,  however,  it  »''  ™™        .  j  t„t  by  the 

'-'•' ^"^.r    nl  r-S;.  o.  human 
Btem  exigencies  of  Uie,  wn  ^^^^  ^  ^^ 

^^"^r  rTr:"-:tely  conscious  ol 
r;^r^'or-su«e.ng.andoithoseine.tab^^ 

Btege  accessories-doctor  "^^  n^^^       ^^^  ^^aical  pro- 
H  Menibers  ^'^/^^.f/;^^^^^^^^  a  larger 

fession.  composed  chiefly  o^JJ^^'  ^^  i^ast.  the 

share  of  attention  and  regard,  you  have 

satisfaction  of  ^^^^^^'^^^^^^iZ^^^^^^  books 

the  more  honourable  calling    J^  °^^  ^*     j,^    ,ten  an 

o,  Solonion^^-^tXg"  e^r^^^^^^  E^och.  and 
early  grandmother,  bending  ^  ^^  ^^^^ 

Bhowir.g  Mahala  how  to  soothe  his  ^^''^         ,    ^^  ^ 
I-       -la     Woman   "  the  link  among  the  days,    »u 
his  pains.    Woman,  successive  generations, 

trained  in  a  bitter  school,  has  m  ^^^^^^       ^^^^^ 
played  the  part  of  Mahala  to  the  little  Enoc^' '^^ 

^       ,  A,.A   Tanoplot        It  SCCmS  a    lar  cry    uui^a 

to  the  wounded  I^^^^*'    \      ^j  ^amelot  to  the  Johns 
plain  of  Mesopotamia  and  the  l^^^^j  V'  ^j^  ^^^^ 

Hopkins  Hospital,  but  the  spirit  which  makes 


DOCTOR  AND  NURSE 

posttble  is  the  same,  tempered  through  the  ages,  by  the 
benign  influence  of  Christianity.    Among  the  ancients, 
many  had  riaen  to  the  idea  of  forgiveness  of  enemies,  of 
patience  mider  wrong  doing,  and  even  of  the  brotherhood 
of  man ;  but  the  spirit  of  Love  only  received  its  mcama- 
tion  with  the  ever  memorable  reply  to  the  ever  memor- 
able question,  Who  is  my  neighbour  1-a  reply  which  has 
changed  the  attitude  of  the  world.    Nowhere  in  ancient 
history,  sacred  or  profane,  do  we  find  pictures  of  devoted 
heroism  in  women  such  as  dot  the  annals  of  the  CathoUc 
Church,  or  such  as  can  be  paralleled  in  our  own  century. 
Tender   maternal   affection,   touching   filial  piety   were 
there;  but  the  spirit  abroad  wf        at  of  Deborah  not 
Rizpah,  of  Jael  not  Dorcas. 

In  the  gradual  division  of  labour,  by  which  civihxation 
has  emerged  from  barbarism,  the  doctor  and  the  nurse 
have  beeu  evolved,  as  useful  accessories  in  the  mcesfant 
warfare  in  which  man  is  engaged.  The  history  of  the 
race  is  a  grim  record  of  passions  and  ambitions,  of  weak- 
nesses and  vanities,  a  record,  too  often,  of  barbaric  in- 
humanity, and  even  to-day,  when  philosophers  would 
hav  '  believe  his  thoughts  had  widened,  he  is  ready  as 
of  )  chut  the  ga^os  of  mercy,  and  to  let  loose  the  dogs 

of  vs -i.  It  was  in  o^e  of  these  attacks  of  race-mania  that 
your  profession,  until  then  unsettled  and  ill-defined, 
took,  under  Florence  Nightingale-«ver  blessed  be  her 
name— its  modern  position. 

IndividuaUy.  man,  the  unit,  the  microcosm,  is  fast  bound 
in  chains  of  atavism,  inheriting  legacies  of  feeble  wiU  and 
strong  desires,  taints  of  blood  and  brain.  What  wonder, 
then,  that  many,  sore  let  and  hindered  in  running  the 

17  0 


I  \ 


DOCTOR  AND  NURSE 
race.  faU  by  the  way.  and  need  a  shelter  in  which  to 
recruit  or  to  die.  a  hospital,  in  which  there  shall  be  no  harsh 
comments  on  conduct,  but  only,  so  far  as  «  possible, 
love  and  peace  and  rest  ?    Here,  we  learn  to  scan  gently 
our  brother  man,  judging  not,  asking  no  questions,  but 
meting  out  to  aU  alike  a  hospitality  worthy  oi  th^  Hotd 
Dieu,  and  deeming  ourselves  honoured  in  being  allowed 
to  act  as  its  dispensers.    Here,  too,  are  daUy  before  our 
eyes  the  problems  which  have  ever  perplexed  the  human 
mind ;  problems  not  presented  in  the  dead  abstract  of 
books,  but  in  the  living  concrete  of  some  poor  fellow  in 
his  last  round,  fighting  a  brave  fight,  but  sadly  weighted, 
and  going  to  his  account  "unhouseU'd.   disappointed, 
unanel'd.  no  reckoning  made."    As  we  whisper  to  each 
other  over  his  bed  that  the  battle  is  decided  and  Euthanasia 
alone  remains,  have  I  not  heard  in  reply  to  that  muttered 
proverb,  so  often  on  the  lips  of  the  physician.  "  the  fathers 
have  eaten  sour  grapes,"  your  answer,  in  clear  accents- 
the  comforting  words  of  the  prayer  of  Step    n1 

But  our  work  would  be  much  restricted  were  it  not 
for  man's  outside  adversary-Nature,  the  great  Moloch, 
which  exacts    a  frightful  tax  of    human  blood,  spar- 
ing neither  young  nor  old ;  taking  the  chUd  from  the 
cradle,  the  mother  from  her  babe,  and  the  father  from 
the  fanuly.      Is  it  strange   that  man,  unable   to  dis- 
sociate a  personal  element  from  such  work,  has  incarnated 
an  evU  principle  -  the  devil?    If   we  have  now   so  far 
outgrown  this  idea  as  to  hesitate  to  suggest,  in  seasons  of 
epidemic  peril,  that  "  it  is  for  our  sins  we  suffer  "—when 
we  know  the  drainage  is  bad ;  if  we  no  longer  mock  the 
heart  prostrate  m  the  grief  of  loss  with  the  words  "  whom 

18 


I 


i 
1 


I 


DOCTOR  AND  NURSE 
the  Lord  loveth  He  chastencth  "—when  we  know  the  mUk 
should  have  been  sterilized— if ,  I  say,  we  have,  in  a  measure, 
become  emancipated  from  such  teachings,  we  have  not 
yet  risen  to  a  true  conception  of  Nature.    Cruel,  in  the 
sense  of  being  inexorable,  she  may  be  called,  but  we  can 
no  more  upbraid  her  great  laws  than  we  can  the  lesser 
laws  of  the  state,  which  are  a  terror  only  to  evildoers. 
The  pity  is  that  we  do  not  know  them  all ;  in  our  ignor- 
ance  we  err  daily,  and  pay  a  blood  penalty.    Fortunately 
it  is  now  a  great  and  growing  function  of  the  medical  pro- 
fession to  search  out  the  laws  about  epidemics,  and  these 
outside  enemies  of  man,  and  to  teach  *o  you,  the  pubUc— 
dull,  stupid  pupils  you  are,  too,  as  i.  rule— the  ways  of 
Nature,  that  you  may  walk  therein  and  prosper. 

It  would  be  interesting.  Members  of  the  Graduatmg 
aass,  to  cast  your  horoscopes.  To  do  so  coUectively 
you  would  lot  like  ;  to  do  so  individually— I  dare  not ; 
but  it  is  safe  to  predict  certain  things  of  you,  as  a  whole. 
You  wiU  be  better  women  for  the  life  which  you  have  led 
here.  But  what  I  mean  by  "  better  women  "  is  that  the 
eyes  of  your  souls  have  been  opened,  the  range  of  your 
sympathies  has  been  widened,  and  your  characters  have 
been  moulded  by  the  events  in  which  you  have  been 
participators  during  the  past  two  years. 

Practically  there  should  be  for  each  of  you  a  busy,  useful, 
and  happy  life  ;  more  you  cannot  expect ;  a  greater  bles- 
sing the  world  cannot  bestow.  Busy  you  will  certainly 
be,  as  the  demand  is  great,  both  in  private  and  public, 
for  women  with  your  training.  Useful  your  lives  must  be, 
as  you  will  care  for  those  who  cannot  care  for  themselves, 
and  who  need  about  ^^^liem,  in  the  day  of  tribulation,  gentle 

19 


»■ 


\ 


DOC?rOE  AND  NUB8B 

hftncU  end  tender  hearts.  And  happy  lives  shall  be  yours, 
because  busy  and  useful ;  having  been  initiated  into  the 
great  secret— that  happiness  lies  in  the  absorption  in 
some  vocation  which  satisfies  the  soul ;  that  we  have  here 
to  add  what  we  can  to,  not  to  get  what  we  can  from,  life. 
And,  finally,  remember  what  we  are— useful  super- 
numeraries in  the  battle,  simply  stage  accessories  in  the 
drama,  playing  minor,  but  essential,  parts  at  the  exits  and 
entrances,  or  picking  up,  here  and  there,  a  strutter,  who 
may  have  tripped  upon  the  stage.  You  have  been  much 
by  the  dark  river  —  so  near  to  us  all  —  and  have  seen  so 
many  embark,  that  the  dread  of  the  old  boatman  has 
almost  disappeared,  and 

When  tha  Angel  of  the  darker  Drink 

At  last  shall  find  you  by  the  river  brink, 

And  offering  his  cup,  invite  your  soul 

Forth  to  your  lips  to  quaff —you  shall  not  shrink : 

your  passport  shall  be  the  blessing  of  Him  in  whose  foot- 
steps you  have  trodden,  unto  whose  sick  you  have  minis- 
tered, and  for  whose  children  you  have  cared. 


V  t'" 

M 


20 


Ill 


TEACHER  AND  STUDENT 


21 


mmmmt 


A  University  consists,  and  has  ever  consisted,  in  demand  and 
supply,  in  wants  wWch  it  alone  can  satisfy  and  which  it  does  satisfy, 
in  the  communication  of  knowledge,  and  the  relation  and  bond 
which  exists  between  the  teacher  and  the  taught.  Ito  constituting, 
animating  principle  is  this  moral  attraction  of  one  class  of  persons 
to  another ;  which  is  prior  in  its  nature,  nay  commonly  m  its  hiHtory. 
to  any  other  tie  whatever ;  so  that,  where  this  is  wanting,  a  Um- 
versity  is  alive  only  in  name,  and  has  lost  its  true  essence,  whatever 
be  the  advantages,  whether  of  position  or  of  affluence,  with  which 
the  civU  power  or  private  benefactors  contrive  to  encircle  it. 

John  Henby  Newman. 

It  would  seem,  Adeimantus,  that  the  direction  in  which  education 
starts  a  man  will  determine  his  future  life. 

Plato.  Republic,  iv.— Jowett's  TranslaUon. 


22 


L 


III 


TEACHER   AND   STUDENT* 

I 

TRULY  it  may  be  said  to-day  that  in  the  method*  of 
teaching  medicine  the  old  order  changeth,  giving 
place  to  new,  and  to  this  revolution  let  me  briefly  refer, 
since  it  has  an  immediate  bearing  on  the  main  point  I  wish 
to  make  in  the  first  portion  of  my  address.  The  medical 
schools  of  the  country  have  been  either  independent.  Uni- 
versity, or  State  Institutions.  The  first  class,  by  far  the 
mc3v  numerous,  have  in  title  University  affiliations,  but 
are  actually  devoid  of  organic  imion  with  seats  of  learning. 
Necessary  as  these  bodies  have  been  in  the  past,  it  is  a 
cause  for  sincere  congratulation  that  the  number  is  steadily 
diminishing.  Admirable  in  certain  respects— adorned  too 
in  many  instances  by  the  names  of  men  who  bore  the  bur- 
den and  heat  of  the  day  of  small  thii.  •?»,  and  have  passed  to 
their  r«  >  amid  our  honoured  dead — the  truth  must  be 
acknowledged  that  the  lamentable  state  of  medical 
education  in  this  coimtry  twenty  years  ago  was  the  direct 
result  of  the  inherent  viciouaness  of  a  system  they  fostered. 
Something  in  the  scheme  gradually  deadened  in  the  pro- 
fessors all  Sense  of  the  responsibility  until  they  professed 
to  teach  (mark  the  word),  in  less  than  two  years,  one  of 

^  Unirenity  of  Minnesota,  1892. 
23 


I 


TEACHER  AND  STUDENT 

the  most  difficult  arta  in  the  world  to  acquire.  Fellow 
teachers  in  medicine,  believe  me  that  when  fifty  or  sixty 
years  hence  some  historian  traces  the  development  of  the 
profession  in  this  country,  he  will  dwell  on  the  notable 
achievements,  on  the  great  discoveries,  and  on  the  un- 
wearied devotion  of  its  members,  but  he  will  pass  judg- 
ment— yes,  severe  judgment — on  the  absence  of  the  sense 
of  responsibility  which  permitted  a  criminal  h.at;  m 
medical  education  unknown  before  in  our  annals.  But 
an  awakening  has  come,  and  there  is  sounding  the  knell 
of  doom  for  the  medical  college,  responsible  neither  to  the 
public  nor  the  profession. 

T  'a  with  close  university  connexions  have  been 

the  m>  isive  and  thorough  in  this  country.    The 

revolutiou  d  to  began  some  twenty  years  ago  with 

the  appearance  of  the  President  of  a  well-known  University 
at  a  meeting  of  its  medical  faculty  with  a  peremptory  com- 
mand to  set  their  house  in  order.*  Universities  which 
teach  only  the  Liberal  Arts  remain  to-day,  as  in  the  middle 
ages,  Scholse  minores,  lacking  the  technical  faculties  which 
make  the  Scholee  majores.  The  advantages  of  this  most 
natural  vmion  are  manifold  and  reciprocal.  The  profes- 
sors in  a  University  medical  school  have  not  that  inde- 
pendence of  which  I  have  spoken,  but  are  under  an 
influence  which  tends  constantly  to  keep  them  at  a  high 
level ;  they  are  urged  by  emulation  with  the  other  faculties 
to  improve  the  standard  of  work,  and  so  are  given  a 
strong  stimulus  to  further  development. 

To  anyone  who  has  watched  the  growth  of  the  new 

1  Seo  Holmes  on  President  Eliot  in  Life  aiid  Letters  of  0.  W. 
Holme*,  1S06.  u.  187, 188, 190. 

24 


TEACHER   AND  STITDENT 

ideas  in  education  it  is  evident  that  the  most  solid  advances 
in  methods  of  teaching,  the  improved  equipment,  clinical 
and  laboratory,  and  the  kindlier  spirit  of  generous  rivalry— 
which  has  replaced  the  former  debased  method  of  counting 
heads  as  a  test  of  merit — all  these  advantages  have  come 
from  a  tightening  of  the  bonds  between  the  medical  school 
and  the  University. 

And  lastly  there  are  the  State  schools,  of  which  tnis 
college  is  one  of  the  few  examples.    It  has  been  a  char- 
acteristic  of    American   Institutions   to   foster  private 
industries  and  to  permit  private  corporations  to  meet  any 
demands  on  the  part  of  the  public.    This  idea  carried  to 
extreme  allowed  the  unrestricted  manufacture — note  the 
term— of  doctors,  quite  regardless  of  the  qualifications 
usually  thought  necessary  in  civilized  communities — of 
physicians  who  may  never  have  been  inside  a  hospital 
ward,  and  who  had,  after  graduation,  to  Isarn  medicine 
somewhat  in  the  fashion  of  the  Chinese  doctors  who  re- 
cognized the  course  of  the  arteries  of  the  body,  by  noting 
just  where  the  blood  spurted  when  the  acupuncture  needle 
was  inserted.     So  far  as  I  know,  State  authorities  have 
never  interfered  with  any  legally  instituted  medical  school, 
however  poorly  equipped  for  its  work,  however  lax  the 
qualifications  for  licen'ie.    Not  only  has  this  policy  of 
non-intervention  boeri  carried  to  excess,  but  in  many 
States  a  few  physiciais  in  any  town  could  get  a  charter 
for  a  school  withe  it  giving  guarantees  that  laboratory  or 
clinical   facilities   would   be   available.    This   anomalous 
condition  is  rapidly  changing,  owing  partly  to  a  revival 
of  loyalty  to  higher  ideals  within  the  medical  profession, 
and  partly  to  a  growing  appreciation  in  the  public  of  the 

25 


1 


TEACHER  AND  STUDENT 


I 


IP 


value  of  physicians  thoroughly  educated  in  modern 
methods.  A  practical  acknowledgment  of  this  is  found 
in  the  recognition  in  three  States  at  least  of  medicine  as 
one  of  the  technical  branches  to  be  taught  in  the  University 
supported  by  the  people  at  large. 

But  it  is  a  secondary  matter,  after  all,  whether  a  school 
is  under  State  or  University  control,  whether  the  endow- 
ments are  great  or  small,  the  equipments  palatial  or 
humble ;  the  fate  of  an  institution  rests  not  on  these ; 
the  inherent,  vital  element,  which  transcends  all  material 
interests,  which  may  give  to  a  school  glory  and  renown 
in  their  absence,  and  lacking  which,  all  the  "  pride,  pomp 
and  circumstance  "  are  vain — this  vitalizing  element,  I 
say,  lies  in  the  men  who  work  in  its  halls,  and  in  the  ideals 
which  they  cherish  and  teach.  There  is  a  passage  in  one 
of  John  Henry  Newman's  Historical  Sketches  which  ex- 
presses this  feeling  in  terse  and  beautiful  language :  "  I 
say  then,  that  the  personal  influence  of  the  teacher  is 
able  in  some  sort  to  dispense  with  an  academical  system, 
but  that  system  cannot  in  any  way  dispense  with  personal 
influence.  With  influence  there  is  life,  without  it  there 
is  none  ;  if  influence  is  deprived  of  its  due  position,  it  will 
not  by  those  means  be  got  rid  of,  it  will  only  break  out 
irregxilarly,  dangerously.  An  academical  system  without 
the  personal  influence  of  teachers  upon  pupils,  is  an  Arctic 
winter ;  it  will  create  an  ice-bound,  petrified,  cast-iron 
University,  and  nothing  else." 

Naturally  from  this  standpoint  the  selection  of  teachers 

is  the  function  of  highest  importance  in  the  Regents  of 

a  University.    Owing  to  local  conditions  the  choice  of  men 

for  certain  of  the  chairs  is  restricted  to  residents  in  the 

26 


i 


TEACHER   AND  STUDENT 

University  town,  as  the  salaries  in  most  schools  of  this 
country  have  to  be  supplemented  by  outside  work.    But 
in  all  departments  this  principle  should  be  acknowledged 
and  acted  upon  by  trustees  and  faculties,  and  supported 
by  public  opinion — that  the  very  best  men  available 
should  receive  appointments.    It  is  gratifying  to  note  the 
broad  liberality  displayed  by  American  colleges  in  welcom- 
ing from  all  parts  teachers  who  may  have  shown  any 
special  fitness,  emulating  in  this  respect  the  liberality  of 
the  Athenians,  in  whose  porticoes  and  lecture  halls  the 
stranger  was  greeted  as  a  citizen  and  judged  by  his  mental 
gifts  alone.    Not  the  least  by  any  means  of  the  object 
lessons  taught  by  a  great  University  is  that  literature 
and  science  know  no  country,  and,  as  has  been  well  said, 
acknowledge  "  no  sovereignty  but  that  of  the  mind,  and 
no  nobility  but  that  of  genius.'    But  it  is  difficult  in  this 
matter  to  guide  public  opinion,  and  the  Regents  have 
often  to  combat  a  provincialism  which  is  as  fatal  to  the 
highest  development  of  a  University  as  is  the  shibboleth 
of  a  sectarian  institution. 


II 

To  paraphrase  the  words  of  Matthew  Arnold,  the 
function  of  the  teacher  is  to  teach  and  to  propagate  the 
best  that  is  known  and  taught  in  the  world.  To  teach 
the  current  knowledge  of  the  subject  he  professes— sifting, 
analyzing,  assorting,  laying  down  principles.  To  pro- 
pagate ;  i.e.,  to  multiply,  facts  on  which  to  base  principles 
—experimenting,  searching,  testing.  The  best  that  is 
known  and  taught  in  the  world— nothing  less  can  satisfy 
a  teacher  worthy  of  the  name,  and  upon  us  of  the  medical 

27 


TEACHER  AND  STUDENT 

faculties  lies  a  bounden  duty  in  this  respect,  since  onr  Art, 
co-ordinate  with  human  suffering,  is  cosmopolitan. 

There  are  two  aspects  in  which  we  may  view  the  teacher 
—as  a  worker  and  instructor  in  science,  and  as  practitioner 
and  professor  of  the  art ;  and  these  correspond  to  the 
natural  division  .f  the  faculty  into  the  medical  school 
proper  and  the  hospital. 

In  this  emir  nvy  practical  country  the  teacher  of 
science  has  not  yet  received  full  recognition,  owing  in 
part  to  the  great  expense  connected  with  his  work,  and 
in  part  to  carelessness  or  ignorance  in  the  public  as  to 
the  real   strength  of  a   nation.    To  equip  and   mam- 
tain    separate   Laboratories    in   Anatomy,     Physiology, 
Chemistry   (physiological  and  pharmacological),    Patho- 
logy and  Hygiene,  and  to  employ  skilled  teachers,  who 
shall  spend  all  their    time  in  study  and  instruction, 
require  a  capital  not  to-day  at  the  command  of  any  medical 
school  in  the  land.    There  are  fortunate  ones  with  two  or 
three  departments  well  organized,  not  one  with  all.    In 
contrast,  Bavaria,  a  kingdom  of  the  German  Empire, 
with  an  area  leas  than  this  State,  and  a  population  of  five 
and  a  half  millions,  supports  in  its  three  University  towns 
flourishing  medical  schools  with  extensive  laboratories, 
many  of  which  are  presided  over  by  men  of  world-wide 
reputation,  the  steps  of  whose  doors  are  worn  in  many 
cases  by  students  who  have  crossed  the  Atlantic ;  seeking 
the  wisdom  of  methods  and  the  virtue  of  inspiration  not 
easily  accessible  at  home.    But  there  were  professors  in 
Bavarian  medical  schools  before  Marquette  and  Joliet 
had  launched  their  canoes  on  the  great  stream  which  the 
intrepid  La  Salle  had  discovered,  before  Du  Lhut  met 

28 


TEACHER  AND  STUDENT 

Father  Hennepin  below  the  falls  of  St.  Anthony ;  and 
justioe  compels  us  to  acknowledge  that  while  winning  an 
empire  from  the  back-woods  the  people  of  this  land  had 
more  urgent  needs  than  laboratories  of  research.  All 
has  now  changed.  In  this  State,  for  example,  the  phe- 
nomenal growth  of  which  has  repeated  the  growth  of 
the  nation,  the  wilderness  has  been  made  to  blossom  as 
the  rose,  and  the  evidences  of  wealth  and  prosperity  on 
every  aide  almos.  'rain  one  to  break  out  into  the  now 
old  song,  "  Happ^         lat  people  that  is  m  such  a  case." 

But  in  the  enormous  development  of  material  mterests 
there  is  danger  lest  we  miss  altogether  the  secret  of  a 
nation's  life,  the  true  test  of  which  is  to  be  found  in  its 
intellectual  and  moral  standards.  There  is  no  more  potent 
antidote  to  the  corroding  influence  of  mammon  than  the 
presence  in  a  community  of  a  body  of  men  devoted  to 
science,  living  for  investigation  and  caring  nothing  for 
the  lust  of  the  eyes  and  the  pride  of  life.  We  forget  that 
the  measure  of  the  value  of  a  nation  to  the  world  is  neither 
the  bushel  nor  the  barrel,  but  mind ;  and  that  wheat  and 
pork,  though  useful  and  necessary,  are  but  dross  in  com- 
parison with  those  intellectual  products  which  alone  are 
impershable.  The  kindly  fruits  of  the  earth  are  easily 
grown  ;  the  finer  fruits  of  the  mind  are  of  slower  develop- 
ment and  require  prolonged  culture. 

Each  onft  of  the  scientific  branches  to  which  I  have 
referred  has  been  so  specialized  that  even  to  teach  it 
takes  more  time  than  can  be  given  by  a  single  Professor, 
while  the  laboratory  classes  also  demand  skilled  assistance. 
The  aim  of  a  school  should  be  to  have  these  depart- 
ments in  the  charge  of  men  who  have,  first,  enihutiaam 

29 


IMaJi^^^aUUa 


i\ 


\i  i 


i 
I 


TEACHER  AND  STUDENT 
that  deep  love  of  a  subject,  that  desire  to  teach  and  e^rtend 
it  without  which  all  instruction  becomes  cold  and  lifeless ; 
secondlv    a  jM  versonal  knowledge  of  the  hratwh  tau^M ; 
^ot  u  second-hand  information  derived  from  books,  but 
the   Uving   experience   derived   from   expenmental   and 
practical  work  in  the  best  laboratories.    This  type  of 
instructor  ^s  fortmiately  not  rare  in  American  schools. 
Th3  well-grounded    students   who  have    pursued   thenc 
studies  in  England  and  on  the  Continent  have  added  depth 
and  breadth  to  our  professional  scholarship,  and  theu: 
critical  faculties  have  been  sharpened  to  discern  what  is 
best  in  the  world  of  medicine.    It  is  particularly  m  these 
branches  that  we  need  teachers  of  wide  learning,  whose 
standards  of  work  are  the  highest  known,  and  whose 
methods  are  those  of  the  masters  in  Israel.    Thirdly  men 
are  required  who  have  a  sense  of  obligation,  that  feeling 
which  impels  a  teacher  to  be  also  a  contributor,  and  to  add 
to  the  stores  from  which  he  so  freely  draws.    And  precisely 
here  is  the  necessity  to  know  the  best  that  is  taught  m 
this  branch,  the  world  over.    The  investigator,  to  be  sue 
cessful,  must  start  abreast  of  the  knowledge  of  the  day. 
and  he  differs  from  the  teacher,  who,  living  m  the  present, 
expounds  only  what  is  current,  in  that  his  thorghts  must 
be  in  the  future,  ar.d  his  ways  and  work  in  advance  of  the 
day  in  which  he  lives.    Thus,  unless  a  bacteriologist  uas 
studied  methods  thoroughly,  and  is  famUiar  with  the  ex- 
traordinarily complex  flora  associated  with  healthy  and 
diseased  conditions,  and  keeps  in  touch  with  every  labor- 
atory of  research  at  home  and  abroad,  he  wiU  in  attempting 
original  work,  find  himself  exploring  ground  already  weU- 
known,  and  will  probably  burden  an  already  over-laden 

80 


TEACHER  AND  STUDENT 

literature  with  faulty  and  crude  observations.  To  avoid 
mistakes,  he  must  know  what  is  going  on  in  the  laboratories 
of  England,  France  and  Germany,  as  well  as  in  those  of  his 
own  country,  and  he  must  receive  and  read  x  or  ten 
journals  devoted  to  the  subject.  The  same  need  for  wide 
and  accurate  study  holds  good  in  all  branches. 

Thoroughly  equipped  laboratories,  in  charge  of  men, 
thoroughly  equipped  as  teachers  and  investigators,  is  the 
most  pressing  want  to-day  in  the  medial  schools  of  this 
country. 

The  teacher  as  a  professor  and  practitioner  of  his  art 
is  more  favoured  than  his  brother,  of  whom  I  have  been 
speaking ;  he  is  more  common,  too,  and  less  interesting ; 
though  in  the  eyes  of  "  the  fool  multitude  who  choose  by 
show"  more  important.    And  from  the  standpoint  of 
medicine  as  an  art  for  the  prevention  and  cure  of  disease, 
the  man  who  translates  the  hieroglyphics  of  science  into 
the  plain  language  of  healing  is  certainly  the  more  useful. 
He   is  more  favoured  inasmuch  as   the    laboratory   in 
which  he  works,  the  hospital,  is  a  necessity  in  every  centre 
of   population.     The  same  obligation    rests  on    him  to 
know  and  to  teach  the  best  that  is  known  and  taught 
in   the  world— on  the  surgeon  the  obligation   to  know 
thoroughly  the  scientific  principles  on  which  his  art  is 
based,  to  be  a  maste)-  in  the  technique  of  his  handicraft, 
ever  studying,  modifying,  improving  -.—on  the  physician, 
the  obligation  to  study  the  natural  history  of  diseases 
and  the  means  for  their  prevention,  to  know  the  true 
value  of  regimen,  diet  and  drugs  in  their  treatment,  ever 
testing,    devising,    thinking ;— and   upon  both,  to  teach 
to  their  students  habits  of  reliance,  and  to  be  tr  them 

31 


Uj 


ft'* 

"hi 


!i 


:  i 


i> 


I 


TEACHER  AND  STUDENT 

examples  of  gentleness,  forbearance  and  courtesy  in  dealing 

with  their  suffering  brethren.  .  ^   •    xu«  ,^1.. 

I  would  fain  dweU  upon  many  other  pomts  m  the  rela 
tion  of  the  hospital  to  the  medical  school-on  the  necessx^ 
of  ample,  full  and  prolonged  clinical  mstruction,  and  on 
L  importance  of  bringing  the  ^tude^*  f^^  *^^  ^^^^ 
into  close  contact,  not  through  the  cloudy  knowledge  o 
the  amphitheatre,  but  by  means  of  the  accurate,  cntjcal 
knowle^e  of  the  wards ;  on  the  propnety  of  encoj^apng 
the  younger  men  as  instructors  and  helpers  m  ward  work 
and  on  the  duty  of  hospital  physicians  and  surgeons  to 
:Lbute  to  the  advance  of  their  art-but    pass  on  w.  b 
an  aUusion  to  a  very  delicato  matter  m  college  ^^^^^^ 
From  one  who.  like  themselves,  has  passed  la  erne 
efe  .uarante  ans,  the  seniors  present  will  P^^oy Jewplam 
reinarks  upon  the  disadvanteges  to  a  school  of  havmg  t^ 
many  men  of  mature,  not  to  say  riper,  years.    InsensiWy, 
in  the  fifth  and  sixth  decades,  there  begms  to  (^ep  over 
most  of  us  a  change,  noted  physically  among  other  ways 
the  silvering  of  the  hair  and  that  le^emng  of  ehshcity. 
which  impels  a  man  to  open  rather  than  to  vault  a  five- 
barred  gate.    It  comes  to  all  sooner  or  later  ;  to  some  it  is 
only  too  painfully  evident,  to  others  it  comes  unconsciously. 
Ih  no  pace  perceived.    And  with  most  of  us  this  physical 
change  has  its  mentel  equivalent,  not  necessarily  accom. 
panied  by  loss  of  the  powers  of  appUcation  or  of  judg- 
ment;  on  the  contrary,  often  the  mind  grows  clearer 
and  the  memory  more  retentive,  but  the  change  is  seen 
in  a  weakened  receptivity  and  in  an  mability  to  adapt 
oneself  to  an  altered  intellectual  enviromnent.    It  «  this 
loss  of  mental  elasticity  which  makes  men  over  forty  so 

82 


I    I 


TEACHER  AND  STUDENT 

slow  to  receive  new  truths.  Harvey  complained  in  his 
day  that  few  men  above  this  critical  age  seemed  able  to 
accept  the  doctrine  of  the  circulation  of  the  blood,  and  in 
our  own  time  it  is  interesting  to  note  how  the  theory  of 
the  bacterial  origin  of  certain  diseases  has  had,  as  other 
truths,  to  grow  to  acceptance  with  the  generation  in  which 
it  was  announced.  The  only  safeguard  in  the  teacher 
against  this  lamentable  condition  is  to  live  in,  and  with 
the  third  decade,  in  company  with  the  younger,  more 
receptive  and  progressive  minds. 

There  is  no  sadder  picture  than  the  Professor  who  has 
outgrown  his  usefulness,  and,  the  only  one  unconscious 
of  the  fact,  insists,  with  a  praiseworthy  zeal,  upon  the 
performance  of  duties  for  which  the  circumstances  of  the 
time  have  rendered  him  unfit.  When  a  man  nor  wax 
nor  honey  can  bring  home,  he  should,  in  the  interests  of 
an  institution,  be  dissolved  from  the  hive  to  give  more 
labourers  room ;  though  it  is  not  every  teacher  who  will 
echo  the  sentiment — 

Let  me  not  live  ... 
After  my  flame  lacks  oil,  to  be  the  snuff 
Of  younger  spirits  whose  apprehensive  senses 
All  but  new  things  disdain. 

As  we  travel  farther  from  the  East,  our  salvation  lies 
in  keeping  our  faces  toward  the  rising  sun,  and  in  letting 
the  fates  drag  us,  like  Cacus  his  oxcu,  backward  into  the 
cave  of  oblivion; 


n 


L  r  s 


III 

Students  of  Medicine,  Apprentices  of  the  Guild,  with 
whom  are  the  promises,  and  in  whom  centre   our  hopes 

AE.  88  D 


!t 


fi  * 


II  i 


TEACHER  AND  STUDENT 
—let  me  congratulate  you  on   the    choice  of  calling 
which  ofiers  a  combination  of  intellectual  and  moral 
interests  found  in  no  other  profession,  and  not  met  with 
at  all  in  the  common  pursuits  of  life— a  combination  which, 
b  the  words  of  Sir  James  Paget,  "  offers  the  most  com- 
plete and  constant  union  of  those  three  qualities  which 
have  the  greatest  charm  for  pure  and  active  minds— novelty, 
utility,  and  charity,"    But  I  am  not  he.e  to  laud  our 
profession;  your  presence  here  on  these  benches  is  a 
guarantee  that  such  praise  is  superfluous.    Rather  allow 
me,  in  the  time  remaining  at  my  disposal,  to  talk  of  the 
influences  which  may  make  you  good  students— now  in 
the  days  of  your  pupilage,  and  hereafter  when  you  enter 
upon  the  more  serious  duties  of  life. 

In  the  first  place,  acquire  early  the  A  t  of  Detachment, 
by  which  I  mean  the  faculty  of  isolating  yourselves  from 
the  pursuits  and  pleasures  incident  to  youth.    By  nature 
man  is  the  incarnation  of  idleness,  which  quality  alone, 
amid  the  ruined  remnants  of  Edenic  characters,  remains  in 
all  its  primitive  intensity.    Occasionally  we  do  find  an 
individual  who  takes  to  toil  as  others  to  pleasure,  but  the 
majority  of  us  have  to  wrestle  hard  with  the  original  Adam, 
and  find  it  no  easy  matter  to  scorn  delights  and  live 
laborious  days.    Of  special  importance  is  this  gift  to  those 
of  you  who  reside  for  the  first  time  in  a  large  city,  the 
many  attractions  ^f  which  offer  a  serious  obstacle  to  its 
acquisition.    The  discipline  necessary  to  secure  this  art 
brings  in  its  train  habits  of  self-control  and  forms  a  valu- 
able introduction  to  the  sterner  realities  of  life. 

I  need  scarcely  warn  you  against  too  close  attention  to 
your  studies.    I  have  yet  to  meet  a  medical  student, 

34 


MMI 


TEACHER   AND  STUDENT 

the  hey-day  in  whose  blood  had  been  quite  tamed  in  his 
college  days ;  but  if  you  think  I  have  placed  too  much 
stress  upon  isolation  in  putting  the  Art  of  Detachment 
first  in  order  amongst  the  desiderata  let  me  temper  the 
hard  sajong  by  telling  you  how  with  "labors  assiduous 
due  pleasures  to  mix."  Ask  of  any  active  business  man 
or  a  leader  in  a  profession  the  secret  which  enables  him 
to  accomplish  much  work,  and  he  will  reply  in  one  word, 
system ;  or  as  I  shall  term  it,  the  Virttie  of  Method,  the 
harness  without  which  only  the  horses  of  genius  travel. 
There  are  two  aspects  of  this  subject ;  the  first  relates  to 
the  orderly  arrange  nent  of  your  work,  which  is  to  some 
extent  enforced  by  the  roster  of  demonstrations  and 
lectures,  but  this  you  wc"ld  do  well  to  supplement  in  private 
study  by  a  schedule  in  which  each  hour  finds  its  allotted 
duty.  Thus  faithfully  followed  day  by  day  system  may 
become  at  last  engramed  in  the  most  shiftless  nature,  and 
at  the  end  of  a  semester  a  youth  of  moderate  ability  may 
find  himself  far  in  advance  of  the  student  who  works 
spasmodically,  and  trusts  to  cramming.  Priceless  as  this 
virtue  is  now  in  the  time  of  your  probation,  it  becomes  in 
the  practising  physician  an  incalculable  blessing.  The 
incessant  and  irregular  demands  upon  a  busy  doctor  make 
it  very  difficult  to  retain,  but  the  public  in  this  matter 
can  be  educated,  and  the  men  who  practise  with  system, 
allotting  a  definite  time  of  the  day  to  certain  work,  accom- 
plish much  more  and  have  at  any  rate  a  little  leisure ; 
while  those  who  are  unmethodical  never  catch  up  with 
the  day's  duties  and  worry  themselves,  their  confreres, 
and  their  patients. 
The  other  aspect  of  method  has  a  deeper  significance, 

86 


n 


li. 


TEACHER  AND  STUDENT 

hard  for  you  to  reach,  not  consoling  when  attained,  since 
it  lays  bare  our  weaknesses.    The  practice  of  medicine  is 
an  art,  based  on  science.    Working  with  science,  in  science, 
for  science,  it  has  not  reached,  perhaps  never  will,  the 
dignity  of  a  comp'<^te  science,  with  exact  laws,  like  astron- 
omy or  "ngineein."      Is  there  then  no  science  of  medicine  ? 
Yes,  but  in  parts  only,  such  as  anatomy  and  physiology, 
and  the  extraordinary  development  of  these  branches 
during  the  present  century  has  been  due  to  the  culti- 
vation of  method,  by  which  we  have  reached  some  degree 
of  exactness,  some  certainty  of  truth.    Thus  we  can  weigh 
the  secretions  in  the  balance  and  measiire  the  work  of  the 
heart  in  foot-pounds.    The  deep  secrets  of  generation 
have  been  revealed  and  the  sesame  of  evolution  has  given 
us  fairy  tales  of  science  more  enchanting  than  the  Arabian 
Nights'  entertainment.    With  this  great  increase  in  our 
knowledge  of  the  laws  governing  the  processes  of  life,  ha& 
been  a  corresponding,  not  less  remarkable,  advance  in  all 
that  relates  to  life  in  disorder,  that  is,  disease.    The 
mysteries  of  heredity  are  less  mysterious,  the  operating- 
room  has  been  twice  over  robbed  of  its  terrors ;  the  laws 
of  epidemics  are  known,  and  the  miracle  of  the  threshing 
floor  of  Araunah  the  Jebusite,  may  be  repeated  in  any 
town  out  of  Bumbledom.    All  this  change  has  come  about 
by  the  observation  of  facts,  by  their  classification,  and 
by  the  founding  upon  them  of  general  laws.    Emulating 
the  persistence  and  care  of  Darwin,  we  must  collect  facts 
with    open-minded  watchfulness,  unbiased  by  crotchets 
or  notions ;  fact  on  fact,  instance  on  instance,  experiment 
on  experiment,  facts  which  fitly  joined  together  by  some 
master  who  grasps  the  idea  of  their  relationship  may  estab- 

86 


■ii 


TEACHER  AND  STUDENT 


lish  a  general  principle.  But  in  the  practice  of  medicine, 
where  our  strength  should  be  lies  our  great  weakntas. 
Our  study  is  man,  as  the  subject  of  accidents  or  diseases. 
Were  he  always,  inside  and  outside,  cast  in  the  same  mould, 
instead  of  differing  from  his  fellow  man  as  much  in  consti- 
tution and  '.i\  his  reaction  to  stimulus  as  in  feature,  we 
should  ere  this  have  reached  some  settled  principles  in  our 
art.  And  not  only  arc  the  reactions  themselves  variable, 
but  ne,  the  doctors,  are  so  fallible,  ever  beset  with  the 
common  and  fatal  facility  of  reaching  concliisions  from 
superficial  observations,  and  constantly  misled  by  the 
ease  with  which  our  minds  fall  into  the  nist  of  one  or  two 
experiences. 

And  thirdly  add  to  the  Virtue  of  Method,  the  Quality 
of  TJiorougJniess,  an  element  of  such  importance  that  I  had 
thought  of  making  it  the  only  subject  of  my  remarks. 
Unfortunately,  in  th«»  present  arrangement  of  the  curri- 
culum, few  of  you  as  student:  can  hope  to  obtain  more 
than  a  measure  of  it,  but  all  can  learn  its  value  now,  and 
ultimately  with  patience  be  jome  living  examples  of  its 
benefit.  Let  me  tell  you  briefly  what  it  means.  A 
knowledge  of  the  fundamental  sciences  upon  which  our 
art  is  based — chemistry,  anatomy,  and  physiology — not 
a  smattering,  but  a  full  and  deep  acquaintance,  not  with 
all  the  facts,  that  is  impossible,  but  with  the  great  principles 
based  upon  them.  You  should,  as  students,  become 
familiar  with  the  methods  by  which  advances  in  knowledge 
are  made,  and  in  the  laboratory  b?e  clearly  the  paths  the 
great  masters  have  trodden,  though  you  yourselves  cannot 
walk  therein.  With  a  good  preliminary  training  and  a 
due  apportion'Jig  of  time  you  can  reach  in  these  three  essen- 

37 


)  " 


TEACHER   AND  STUDENT 


il., 


tial  studies  a  degree  of  accuracy  which  is  the  true  prepara* 
tion  for  your  life  duties.  It  means  such  a  knowledge  of 
diseases  and  of  the  emergencies  of  life  and  of  the  means 
for  their  alleviation,  that  you  are  safe  and  trustworthy 
guides  for  your  fellowmen.  You  cannot  of  course  in 
the  brief  years  of  pupilage  so  grasp  the  details  of  the  various 
branches  that  you  can  surely  recognize  and  successfully 
treat  all  cases.  But  uere  if  you  have  mastered  certain 
principles  is  at  any  rate  one  benefit  of  thoroughness — 
you  will  avoid  the  sloughs  of  charlatanism.  Napoleon, 
according  to  Sainte  Beuve,  one  day  said  when  somebody 
was  spoken  of  in  his  presence  as  a  charlatan,  "  Charlatan 
as  much  as  you  please,  but  where  is  there  not  charlatan- 
ism '  "  Now,  thoroughness  is  the  sole  preventive  of  this 
widespread  malady,  which  in  medicine  is  not  met  with 
only  outside  of  the  profession.  Matthew  Arnold,  who 
quotes  the  above  from  Sainte  Benve,  defines  charlatanism 
as  the  "  confusing  or  obliterating  the  distinctions  between 
excellent  and  inferior,  sound  and  unsound,  or  only  half 
sound,  true  and  untnie  or  half  true."  The  higher  the 
standard  of  education  in  a  profession  the  less  marked  will 
be  the  charlatanism,  whereas  no  greater  incentive  to  its 
development  can  be  found  than  in  sending  out  from  our 
colleges  men  who  have  not  had  mental  training  sufficient 
to  enable  them  to  judge  between  the  excellent  and  the 
inferior,  the  sound  and  the  unsound,  the  true  and  the  half 
true.  And  if  we  of  the  household  are  not  free  from  *he 
seductions  of  this  vice,  what  of  the  people  among  whom 
we  work  ?  From  the  days  of  the  sage  of  Endor,  even  the 
rulers  have  loved  to  dabble  in  it,  while  the  public  of  all 
ages  have  ever  revelled  in  its  methods — to-day,  as  in  the 

88 


TEACHER  AND  STUDENT 

time  of  the  Father  of  M  e,  one  of  whose  contempor- 

aries (Plato)  thir  'etcti  B  the  world  old  trait:  "And 
what  a  delightful  liie  they  lead  !  they  are  always  doctoring 
and  increasing  and  complicating  their  disorders  and  always 
fancying  they  will  be  cured  by  any  nostrum  which  anybody 
advises  them  to  try." 

The  Art  of  Detachment,  the  Virtue  of  Method,  and  the 
Quality  of  Thoroughness  may  make  you  students,  in  the 
true  sense  of  the  word,  successful  practitioners,  or  even 
great  investigators ;  but  your  characters  may  still  lack  that 
which  can  alone  give  permanence  to  powers — the  Grace  of 
HumUity.  As  the  divine  Italian  at  the  very  entrance  to 
Purgatory  was  led  by  his  gentle  Master  to  the  banks  of 
the  island  and  girt  with  a  rush,  indicating  thereby  that  he 
had  cast  off  all  pride  and  self-conceit,  and  was  prepared 
for  his  perilous  ascent  to  the  realms  above,  so  should  you, 
now  at  the  outset  of  your  journey  take  the  reed  of  humility 
in  your  hands,  in  token  that  you  appreciate  the  length  of 
the  way,  the  difficulties  to  be  overcome,  and  the  fallibility 
of  the  faculties  upon  which  you  depend. 

In  these  days  of  aggressive  self-assertion,  when  the 
stress  of  competition  is  so  keen  and  the  desire  to  make  the 
most  of  oneself  so  universal,  it  may  seem  a  little  old- 
fashioned  to  preach  the  necessity  of  this  virtue,  but  I  insist 
for  its  own  sake,  and  for  the  sake  of  what  it  brings,  that  a 
due  humility  should  take  the  place  of  honour  on  the  list. 
For  its  own  sake,  since  with  it  comes  not  only  a  reverence 
for  truth,  but  also  a  proper  estimation  of  the  difficulties 
encountered  in  our  search  for  it.  More  perhaps  than  any 
other  professional  man,  the  doctor  has  a  curious — shall 
I  say  morbid  ?— sensitiveness  to  (what  he  regards)  per- 


il 


TEACHER  AND  STUDENT 
sonal  error.  In  a  way  this  is  right ;  but  it  is  too  often 
accompanied  by  a  cocksureneas  of  opinion  which,  if  en- 
couraged, leads  him  to  so  lively  a  conceit  that  the  mere 
suggestion  of  mistake  under  any  circumstances  is  regarded 
as  a  reflection  on  his  honour,  a  reflection  equally  resented 
whether  of  lay  or  of  professional  origin.  Start  out  with 
the  conviction  that  absolute  truth  is  hard  to  reach  in 
matters  relating  to  our  fellow  creatures,  healthy  or  diseased, 
that  slips  in  observation  are  inevitable  even  with  the  best 
trained  faculties,  that  errors  in  judgment  must  occur  in 
the  practice  of  an  art  which  consists  largely  in  balancing 
probabilities ;— start,  I  say,  with  this  attitude  of  mind, 
and  mistakes  will  be  acknowledged  and  regretted;  but 
instead  of  a  slow  process  of  self-deception,  with  ever  in- 
creasing inability  to  recognize  truth,  you  will  draw  from 
your  errors  the  very  lessons  which  may  enable  you  to  avoid 
theur  repetition. 

And,  for  the  sake  of  what  it  brings,  this  grace  of  humility 
is  a  precious  gift.  When  to  the  sessions  of  sweet  silent 
thought  you  summon  up  the  remembrance  of  your  own 
imperfections,  the  faults  of  your  brothers  will  seem  less 
grievous,  and,  in  the  quaint  language  of  Sir  Thomas 
Browne,  you  wiU  "  allow  one  eye  for  what  is  laudable  in 
them."  The  wrangling  and  unseemly  disputes  which 
have  too  often  disgraced  our  profession  arise,  in  a  great 
majority  of  cases,  on  the  one  hand,  from  this  morbid  sen- 
sitiveness to  the  confession  of  error,  and,  on  che  other, 
from  a  lack  of  brotherly  consideration,  and  a  convenient 
forgetfdness  of  our  own  faUings.  Take  to  heart  the  words 
of  the  son  of  Sirach,  winged  words  to  the  sensitive  souls 
of  the  sons  of  Esculapius :  "  Admonish  a  friend,  it  may 

40 


TEACHER  AND  STUDENT 


be  he  has  not  done  it ;  and  if  he  have  done  it,  that  he  do  it 
no  more.  Admonish  thy  friend,  it  may  be  he  hath  not 
said  it ;  and  if  he  have,  that  he  speak  it  not  again.  Ad- 
monish a  friend,  for  many  times  it  is  a  slander,  and  believe 
not  every  tale."  Yes,  many  times  it  is  a  slander,  and  be- 
lieve not  every  tale. 

The  truth  that  lowliness  is  young  ambition's  ladder 
is  hard  to  grasp,  and  when  accepted  harder  to  maintain. 
It  is  so  difficult  to  be  still  amidst  bustle,  to  be  quiet  amidst 
noise ;  yet,  "  es  hUdet  ein  Talent  sick  in  der  Stille  "  alone, 
in  the  calm  life  necessary  to  continuoiis  work  for  a  high 
purpose.  The  spirit  abroad  at  present  in  this  country 
is  not  favourable  to  this  Teutonic  view,  which  galls  the 
quick  apprehension  and  dampens  the  enthusiasm  of  the 
young  American.  All  the  same,  it  is  true,  and  irksome 
at  first  though  the  discipline  may  be,  there  will  come  a  time 
when  the  very  fetters  in  which  you  chafed  shall  be  a  strong 
defence,  and  your  chains  a  robe  of  glory. 

Sitting  in  Lincoln  Cathedral  and  gazing  at  one  of  the 
loveliest  of  human  works — for  such  the  angel  Choir  has 
been  said  to  be — there  arose  within  me,  obliterating  for 
the  moment  the  thousand  heraldries  and  twilight  saints  and 
dim  emblazonings,  a  strong  sense  of  reverence  for  the  minds 
which  had  conceived  and  the  hands  which  had  executed 
such  things  of  beauty.  What  manner  of  men  were  they 
who  could,  in  those  (to  us)  dark  days,  build  such  trans- 
cendent monuments  ?  What  was  the  secret  of  then-  art  ? 
By  what  spint  were  they  moved  ?  Absorbed  in  thought, 
I  did  not  hear  the  beginning  of  the  music,  and  then,  as  a 
response  to  my  reverie  and  arousing  me  from  it,  rang  out 
the  clear  voice  of  the  boy  leading  the  antiphon,  "  That  thy 

41 


■# 
■^ 


o 


i  I 


TEACHER  AND  STUDENT 

power,  thy  glory  and  mightiness  of  thy  kingdom  might 
be  known  unto  men."  Here  was  the  answer.  Moving  in 
a  world  not  realized,  these  men  sought,  however  feebly, 
to  express  in  glorious  structures  their  conceptions  of  the 
beauty  of  holiness,  and  these  works,  our  wonder,  are  but 
the  outward  and  visible  signs  of  the  ideals  which  animated 
them. 

To  us  in  very  different  days  life  offers  nearly  the  same 
problems,  but  the  conditions  have  changed,  and,  as  has 
happened  before  in  the  world's  history,  great  material 
prosperity  has  weakened  the  influence  of  ideals,  and  blurred 
the  eternal  difference  between  means  and  end.  Still, 
the  ideal  State,  the  ideal  Life,  the  ideal  Church — what  they 
are  and  how  best  to  realize  them — such  dreams  continue  to 
haunt  the  minds  of  men,  and  who  can  doubt  that  their  con- 
templation greatly  assists  the  upward  progress  of  our  race  ? 
We,  too,  as  a  profession,  have  cherished  standards,  some 
of  which,  in  words  sadly  disproportionate  to  my  subject, 
I  have  attempted  to  portray. 

My  message  is  chiefly  to  you,  Students  of  Medicine,  since 
with  the  ideals  entertained  now  your  future  is  indissolubly 
bound.  The  choice  lies  open,  the  paths  are  plain  before 
you.  Always  seek  your  own  interests,  make  of  a  high  and 
sacred  calling  a  sordid  business,  regard  your  fellow  creatures 
as  so  many  tools  of  trade,  and,  if  your  heart's  desire  is  for 
riches,  they  may  be  yours ;  but  you  will  have  bartered  away 
the  birthright  of  a  noble  heritage,  traduced  the  physician's 
well-deserved  title  of  the  Friend  of  Man,  and  falsified 
the  best  traditions  of  an  ancient  and  honourable  Guild. 
On  the  other  hand,  I  have  tried  to  indicate  some  of  the 
ideals  which  you  may  reasonably  cherish.    No  matter 

42 


TEACHER  AND  STUDENT 

though  they  are  paradoxical  in  comparLv>n  with  the 
ordinary  conditions  in  which  you  work,  they  will  have,  if 
encouraged,  an  ennobling  influence,  even  if  it  be  for  you 
only  to  say  with  Rabbi  Ben  Ezra,  "  what  I  aspired  to  be 
and  was  not,  comforts  me."  And  though  tuis  course 
does  not  necessarily  bring  position  or  renown,  consistently 
followed  it  will  at  any  rate  give  to  your  youth  an  exhilarating 
zeal  and  a  cheerfulness  which  will  enable  you  to  surmount 
all  obstacles — to  your  maturity  a  serene  judgment  of 
men  and  things,  and  that  broad  charity  without  which 
all  else  is  nought — ^to  your  old  age  that  greatest  of  blessings, 
peace  of  mind,  a  realization,  ma;*be,  of  the  prayer  of 
Socrates  for  the  beauty  in  the  inward  soul  and  for  unity 
''  the  outer  and  the  inner  man ;  perhaps,  of  the  promise  of 
Bernard,  "  pax  sine  crimine,  pax  sine  turbine,  pax  sine 
-a." 


48 


IV 

PHYSIC  AND  PHYSICIANS  AS 
DEPICTED  IN  PLATO 


4b 


Ml 


"  To  one  amall  people  ...  it  ww  given  to  create  the  principle 
of  Progress.  That  people  was  the  Greek.  Except  the  Uind 
forces  of  Nature,  nothing  moves  in  this  world  which  is  not  Greek 
in  its  origin." 

Mains.    Quoted  in  Greek  Thinkera  by  Gomperz. 

From  the  lifeless  background  of  an  unprogressive  world — Egypt 
Syria,  frozen  Scythia — a  world  in  which  the  unconscious  social 
aggr^ate  had  been  everjrthing,  the  conscious  individual,  his 
capacity  and  rights,  almost  nothing,  the  Greek  had  stepped  forth, 
like  the  young  prince  in  the  fable,  to  set  things  going. 

Waltkb  Pateb,  Plato  and  PUUonism. 

These  (years  of  vague,  restless  speculation)  had  now  lasted  long 
enough,  and  it  was  time  for  the  Mei^erjahre  of  quiet,  methodiral 
research  to  succeed  if  science  was  to  acquire  steady  and  sedentary 
habits  instead  of  losing  itself  in  a  maze  of  phantasies,  revolving 
in  idle  circles.  It  is  the  undying  glory  of  the  medical  school  of 
Cos  that  it  introduced  this  innovation  in  the  domain  of  its  art,  and 
thus  exercised  the  mo  t  beneficial  influence  on  the  whole  intellectual 
life  of  mankind.  "  Fiction  to  the  right !  Reality  to  the  left !  " 
was  the  battle-cry  of  this  school  in  the  war  they  were  the  first  to 
wage  against  the  excesses  and  defects  of  the  nature-philosophy. 
Nor  could  it  have  found  any  more  suitable  champions,  for  the 
serious  and  noble  calling  of  the  physician,  which  brings  him  every 
day  and  every  hour  in  close  communion  with  nature,  in  the  exer- 
cise of  which  mistakes  in  theory  engender  the  most  fatal  practical 
consequences,  has  served  in  all  ages  as  a  nursery  of  the  most  genuine 
and  incorruptible  sense  of  truth.  The  best  physicians  must  be 
the  best  observers,  but  the  man  who  sees  keenly,  who  hears  clearly, 
and  whose  senses,  powerful  at  the  start,  are  sharpened  and  refined 
by  constant  exercise,  will  only  in  exceptional  instances  be  a  visionary 
or  a  dreamer. 

GoMFBBZ,  Oruk  Thinkers,  vol  i. 


46 


mam 


IV 

PHYSIC  AND  PHYSICIANS  AS 
DEPICTED   IN  PLATO  ' 

OUR  Historical  Club  had  under  consideration  last 
winter  the  subject  of  Greek  Medicine.  After  in- 
troductory remarks  and  a  description  of  the  iEscuIapian 
temples  and  worship  by  Dr.  Welch,  we  proceeded  to  a 
systematic  study  of  the  Hippocratic  writings,  taking  up 
in  order,  as  found  in  them,  medicine,  hygiene,  surgery, 
and  gynaecology.  Among  much  of  interest  which  we 
gleaned,  not  the  least  important  was  the  knowledge  that 
as  an  art,  medicine  had  made,  even  before  Hippocrates, 
great  progress,  as  much  almost  as  was  possible  without  a 
basis  in  the  sciences  of  anatomy  and  physiology.  Minds 
inquisitive,  acute,  and  independent  had  been  studying  the 
problems  of  nature  and  of  man ;  and  several  among  the 
pre-Socratic  philosophers  had  been  distinguished  physi- 
cians, notably,  Pythagoras,  Empedocles,  and  Democritus. 
Unfortunately  we  know  but  little  of  their  views,  or  even 
of  the  subjects  in  medicine  on  which  they  wrote.  In  the 
case  of  Democritus,  however,  Diogenes  Laertius  has  pre- 
served a  list  of  his  medical  writings,  which  intensifies  the 

1  Johns  Hopkins  Hospital  Historical  Club,  1893. 
47 


PHYSIC  AND  PHYSiaANS 


regret  at  the  loss  of  the  works  of  this  great  man,  the  title 
of  one  of  whose  essays,  "  On  Those  who  are  Attacked  with 
Cough  after  Illness"  indicates  a  critical  observation  of 
disease,  which  Daremberg  seems  unwilling  to  allow  to  the 
pre-Hippocratic  philosopher-physicians. 

We  gathered  also  that  in  the  golden  age  of  Greece, 
medicine  had,  as  to-day,  a  triple  relationship,  with  science, 
with  gymnastics,  and  with  theology.  We  can  imagine  an 
Athenian  father  of  the  early  fourth  centurv  worried  about 
the  enfeebled  health  of  one  of  his  growing  lads,  asking  the 
advice  of  Hippocrates  about  a  suspicious  cough,  or  sending 
him  to  the  palaestra  of  Taureas  for  a  systematic  course  in 
gymnastics ;  or,  as  Socrates  advised,  "  when  human  skill 
was  exhausted,"  asking  the  assistance  of  the  divine  Apollo, 
through  his  son,  the  "  hero-physician,"  .^Isculapius,  at  his 
temple  in  Epidaurus  or  at  Athens  itself.  Could  the  Greek 
live  over  his  parental  troubles  at  the  end  of  the  nineteenth 
century,  he  would  get  a  more  exact  diagnosis  and  a  more 
rational  treatment;  but  he  might  travel  far  to  find  so 
eminent  a  "  professor  "  of  gynmastic  as  Miccus  for  his  boy, 
and  in  Christian  science  or  faith-healing  he  would  find  our 
bastard  substitute  for  the  stately  and  gracious  worship  of 
the  iEsculapian  temple.' 

From  the  Hippocratic  writings  alone  we  have  a  very 


^  For  an  account  of  "  ^sculapius  at  Epidauros  and  Athena," 
chapter  vi.  of  Dyer's  Qoda  of  Oreece  (Maomillan,  1891),  a  chapter 
which  contains  also  aa.  excellent  discussion  on  the  relation  of  secular 
to  priestly  medicine.  In  Chapter  III  cf  Pater's  delightful  story 
Mariua  (he  Epicurean,  is  a  description  of  one  of  the  RomaniEsculapiat 
and  an  account  of  the  method  of  procedure  in  the  "cure,"  the 
ridiculous  aspects  of  which  are  so  graphically  described  in  the 
"  Plutus  "  of  Aristophanes. 

48 


AS  DEPICTED  IN  PLATO 

imperfect  knowledge  of  the  state  of  "ledicine  in  the  most 
brilliant  period  of  Grecian  history ;  and  many  details  re* 
lating  to  the  character  and  to  the  life  of  physicians  are 
gleaned  only  from  secular  authors.  So  much  of  the  daily 
life  of  a  civilized  community  relates  to  problems  of  health 
and  disease  that  the  great  writers  of  every  age  of  necessity 
throw  an  important  side-light,  not  only  on  the  opinions  of 
the  people  on  these  questions,  but  often  on  the  condition  of 
special  knowledge  in  various  branches.  Thus  a  consider* 
able  literature  already  illustrates  the  medical  knowledge 
of  Shakespeare,  from  whose  doctors,  apothecaries,  and 
mad*folk  much  may  be  gathered  as  to  the  state  of  the  pro- 
fession in  the  latter  part  of  the  sixteenth  century.  So  also 
the  satire  of  Molidre,  malicious  though  it  be,  has  preserved 
for  us  phases  of  medical  life  in  the  seventeenth  century, 
for  which  we  scan  in  vain  the  strictly  medical  writings 
of  that  period ;  and  writers  of  our  times,  like  George  Eliot, 
have  told  for  future  generations  in  a  character  such  as 
Lydgate,  the  little  every-day  details  of  the  struggles  and 
aspirations  of  the  profession  of  the  nineteenth  century,  of 
which  we  find  no  account  whatever  in  the  files  of  the  Lancet. 

We  are  fortunate  in  having  had  preserved  the  writings 
of  the  two  most  famous  of  the  Grr-^k  philosophers — the 
great  idealist,  Plato,  whose  "  contemplation  of  all  time  and 
all  existence  "  was  more  searching  than  that  of  his  pre- 
decessors, fuller  than  that  of  any  of  his  disciples,  and  the 
great  realist,  Aristotle,  to  whose  memory  every  department 
of  knowledge  still  pays  homage,  and  who  has  swayed  the 
master-minds  of  twenty-two  centuries.  From  the  writings 
of  both  much  may  be  gathered  about  Greek  physic  and 
physicians ;  but  I  propose  in  this  essay  to  restrict  myself 

AE.  49  E 


It;! 

V 


PHYSIC  AND   PHYSICIANS 

to  what  I  have  culled  from  the  Dialogw*  of  Plato.  I 
shall  first  speak  of  his  physiological  and  pathological  specu- 
lations ;  then  I  shall  refer  to  the  many  interesting  allusions 
to,  and  analogies  drawn  from,  medicine  and  physicians ; 
and,  lastly,  I  shall  try  to  estimate  from  the  Dialogues 
the  social  standing  of  the  Greek  doctor,  and  shall  speak  on 
other  points  which  bear  upon  the  general  condition  of  the 
profession.  The  quotations  are  made  in  every  instance 
from  Professor  Jowett's  translation,  the  third  edition,  1892.' 


■' 


To  our  enlightened  minds  the  anatomy  and  physiol  ,y 
of  Plato  are  crude  and  imperfect ;  as  much  or  even  more 
so  than  those  of  Hippocrates.  In  the  Timaua  he  con- 
ceived the  elements  to  be  made  up  of  bodies  in  the  form  of 
triangles,  the  di£[erent  varieties  and  combinations  of  which 
accounted  for  the  existence  of  the  four  elementary  bodies  of 
Empedocles— fire,  t  th,  water,  and  air.  The  differences 
in  the  elementary  bodies  are  due  to  differences  in  the  size 
and  arrangement  of  the  elementary  triangles,  which,  like 
the  atoms  of  the  atomist,  are  too  small  to  be  visible.  Mar- 
row had  the  most  perfect  of  the  elementary  triangles,  and 
from  it  bone,  flesh,  and  the  other  structures  of  the  body 
were  made.  "  God  took  such  of  the  primary  triangles  as 
were  straight  and  smooth,  and  were  adapted  by  their 
perfection  to  produce  fire  and  water,  and  air  and  earth ; 
these,  I  say,  he  separated  from  their  kinds,  and  mingling 
them  in  due  proportions  with  one  another,  made  the  mar- 

^  The  Dialoguea  of  Plato,  translated  into  English  by  B.  Jowett, 
M.A.,  Master  of  Balliol  College,  Oxford.  At  the  Clarendon  Press, 
fint  edition,  1871 ;  third  edition,  1892. 

50 


? 


AS  DEPICTED  IN  PLATO 
row  out  of  them  to  be  a  universal  seed  of  the  whole  race  of 
mankind ;  and  m  this  seed  he  then  phmted  and  encloaed 
the  souls,  and  in  the  original  distribution  gave  to  the  mar- 
row as  many  and  various  forms  as  the  different  kinds  of 
souls  were  hereafter  to  receive.    That  which,  like  a  t-sld, 
was  to  receive  the  divine  seed,  he  made  round  every  way,* 
and  called  that  portion  of  the  marrow  brain,  intending 
that,  when  an  animal  was  perfected,  the  vessel  containing 
this  substance  should  be  the  head ;  but  that  which  was 
intended  to  contain  the  remaining  and  mortal  part  of  the 
soul  he  distributed  into  figures  at  once  round  and  elon- 
gated, and  he  called  them  all  by  the  name  '  marrow ' ;  and 
to  these,  as  to  anchors,  fastening  the  bonds  of  the  whole 
soul,  he  proceeded  to  fashion  around  them  the  entire  frame- 
work of  our  body,  constructing  for  the  marrow,  first  of  aH, 
a  complete  covering  of  bone." ' 

The  account  of  the  structure  of  bone  and  flesh,  and  of 
functions  of  respiration,  digestion,  and  circulation  is  un- 
intelligible to  our  modem  notions.    Plato  knew  that  the 
blood  was  in  constant  motion ;  in  speaking  of  inspiration  and 
expiration,  and  the  network  of  fire  which  interpenetrates 
the  body,  he  says  :  "  For  when  the  respiration  is  going  in 
and  out,  and  the  fire,  which  is  fast  bound  within,  follows 
it,  and  ever  and  anon  moving  to  and  fro,  enters  the  belly 
and  reaches  the  meat  and  drink,  it  dissolves  them,  and 
dividing  them  into  small  portions,   and  guiding  them 
through  the  passages  where  it  goes,  pumps  them  as  from  a 
fountain  into  the  channels  of  the  veins,  and  makes  the 
stream  of  the  veins  flow  through  the  body  as  through  a  con- 
duU.*^ '    A  complete  circulation  was  unknown  ;  but  Plato 


>  DialoQuu,  iii.  493. 


51 


*  Ibid.  iii.  601. 


liiiTM 


PHYSl.   AN'D   f^HVaiHANS 

understood  fully  that  tlie  blooi  v^as  the  source  of  nourish- 
naeut,— " the  liquid  itself  wc  -aU  blood,  which  nourishes 
the  flesh  and  the  whole  body,  whence  all  parts  are  watered 
and  empty  spaces  fill«J."  *  In  the  young,  the  triangles, 
or  in  modem  parlance  we  would  say  the  atoms,  are  new, 
and  are  compared  tc  the  keel  of  a  vessel  just  off  the  stocks. 
Thoy  are  locked  firnily  together,  but  form  a  soft  and  deli- 
cate mass  freshly  made  of  marrow  and  nourished  on  milk. 
The  process  of  digestion  is  described  as  a  struggle  between 
the  triangles  out  of  which  the  meats  and  drinks  are  com- 
pobed,  and  those  of  the  bodily  frame ;  and  as  the  former 
are  older  and  weaker  the  newer  triangles  of  the  body  cut 
them  up,  and  in  this  way  the  animal  grows  great,  being 
nourished  by  a  multitude  of  similar  particles.  The  triangles 
are  in  constant  fluctuation  and  change,  and  in  the  "  Sym- 
posium "  Socrates  makes  Diotima  say,  "  A  man  is  called 
the  same,  and  yet  in  the  short  interval  which  elapses  be- 
tween vouth  and  age,  and  in  which  every  animal  is  said  to 
have  life  and  identity,  he  is  undergoing  a  perpetual  pro- 
cess of  loss  and  reparation — hair,  flesh,  bones,  and  the 
whole  body  are  always  changing." ' 

The  description  of  senility,  euthanasia,  and  death  is 
worth  quoting :  "  But  uhen  the  roots  of  the  iriangks  are 
loosened  by  having  unaergone  many  conflicts  with  many 
thinnfs  in  the  course  of  time,  they  are  no  longer  able  to  cut 
or  assimilate  the  food  w  lich  enters,  but  are  themselves 
easily  divided  by  the  bodies  which  come  in  from  ^vithout. 
In  this  way  every  animal  is  overcome  and  tiecays,  and  tLis 
affection  is  called  old  age.  And  at  last,  whe-  the  bonds  by 
which  the  triangles  of  the  marrow  are  uniied  no  long^^ 

'  Dialogua,  iii.  503.  >  Ibid.  i.  578. 

52 


AS  DEPICTED   IN  PLATO 

hdd,  and  are  parted  by  r^ie  Btxai  of  eziitenoe,  they  in 
torn  loosen  the  bonds  of  "^e  aor  and  sh  ,  obtaining  tt. 
natural  release,  flies  away  with  joy  For  t  at  which  taker 
place  accorduig  to  uulure  b  pleasant,  but  hat  which  is 
contrciry  to  t^^ture  is  ji^inful.  4nd  thus  deuth,  if  caused 
by  disease  or  ^ produced  by  wounds,  is  painful  and  violent ; 
but  that  sort  of  death  which  comes  with  old  age  and  fulfill 
the  debt  of  natur^>  is  the  easiest  of  deaths,  and  is  accom- 
pani^^  1  with  pleasure  rather  than  with  pain."  ' 

The  mode  of  origin  and  th*-  nature  of  iseaa**.  aa  d^ 
scribed  in  the  TitncBug,  are  in  Keeping  with  this  irimitive 
and  imperfect  science  The  diseases  of  the  bt  ly  ^rise 
when  anyone  of  the  four  -ilement » is  out  of  place,  i  i»en 
the  blood,  sinews  and  flean  axe  produced  m  a  w-"  ^  ord^ \ 
Much  influence  is  attributed  to  the  various  kii.u  '  f  bud. 
The  worst  of  all  diseases,  he  thinks,  are  shr «  '  the  spinal 
marrow,  in  whi  h  the  ^iiole  course  of  the  I  d'  is  reversed. 
Other  disease  are  produced  bv  diso-ders  of  respiration; 
as  by  phleg'-  when  detained  within  hy  rea  >n  of  the  air 
bubbles."  This,  if  mingled  with  bb  k  aile  and  is  ersed 
about  th-'  cou^'ses  of  the  head  prouuce*  ep  pay,  attacks 
of  which  ng  sleep,  hr-  says,  are  not  s  m\  -t  at  when 
it  assails  those  who  are  iwake  it  is  ha^  ^  got  rid  of, 

and  "bei'ig  a  i  u  Section  of  a  sarrcd  par  iio.-tt  justly 

called  sacred"  morhus  SQ<er.  <,)!  ither  Jisoi  lers,  excess 
of  fire  causes  a  contmuous  fever  ;  of  air,  quotidian  fever  j 
of  water,  which  is  a  more  sluggish  clement  than  either  fire 
or  air,  tertian  feve-  ;  of  earth,  the  most  sluggish  element 
of  the  four,  is  onl  purged  away  in  a  luu.-fold  period,  that 
is  in  a  quartan  f    or.'^ 

^  Didoguta,  iii.  603-4.  '  Ibid.  iii.  007-8. 

68 


PHYSIC  AND  PHYSiaANS 


III 


The  psychology  of  Plato,  in  contrast  to  his  anatomy 
and  physiology,  has  a  strangely  modem  savour,  and  the 
three-fold  divisions  of  the  mind  into  reason,  spirit  and 
appetite,  represents  very  much  the  mental  types  recog- 
nized by  students  of  the  present  day.  The  rational,  im- 
mortal principle  of  the  soul  "  the  golden  cord  of  tcason  " 
dwells  in  the  brain,  "  and  inasmuch  as  we  are  a  plant  not 
of  earthly  but  of  heavenly  growth,  raises  us  from  earth  to 
our  kindred  who  are  in  heaven."  The  mortal  soul  con- 
sists of  two  parts ;  the  one  with  which  man  "  loves  and 
hungers  and  thirsts,  and  feels  the  flutterings  of  any  other 
desire,"  is  placed  between  the  midrifi  and  the  boimdary 
of  the  navel ;  the  other,  passion  or  spirit,  is  situated  in 
the  breast  between  the  midriff  and  the  neck,  "  in  order 
that  it  might  be  under  the  rule  of  reason  and  might  join 
with  it  in  controlling  and  restraining  the  desires  when 
they  are  no  longer  willing  of  their  own  accord  to  obey  the 
word  of  command  issuing  from  the  citadel."  ^ 

No  more  graphic  picture  of  the  struggle  between  the 
rational  and  appetitive  parts  of  the  soul  has  ever  been 
given  than  in  the  comparison  of  man  in  the  Phcedrus  to  a 
charioteer  driving  a  pair  of  winged  horses,  one  of  which  is 
noble  and  of  noble  breed ;  the  other  ignoble  and  of  ignoble 
breed,  so  that  "  the  driving  of  them  of  necessity  gives  a 
great  deal  of  trouble  to  him."  ' 

The  comparison  of  the  mind  of  man  in  the  Thecetettu 

to  a  block  of  wax,  "  which  is  of  different  sizes  in  different 

men ;  harder,  moister,  and  having  more  or  less  of  purity 

in  one  than   another,  and   in  some  of  an  intermediate 

quality,"  is  one  of  the  happiest  of  Plato's  conceptions. 

t  Dialoguet,  Hi.  491-2.  *  Ibid.  i.  4S2.. 

64 


AS  DEPICTED   IN  PLATO 

This  wax  tablet  is  a  gift  of  Memory,  the  mother  of  the 
Muses ;  "  and  when  we  wish  to  remember  anything  which 
we  have  seen,  or  heard  or  thought  in  our  own  minds,  we 
hold  the  wax  to  the  perceptions  and  thoughts,  and  in  that 
material  receive  the  impression  of  the  .  as  from  the  seal 
of  a  ring ;  anJ  that  we  remember  and  know  what  is  im- 
printed as  long  as  the  image  lasts ;  but  when  the  image- 
is  effaced,  or  cannot  be  taken,  then  we  forget  and  do  not 
know." ' 

Another  especially  fortunate  comparison  is  that  of  the 
mind  to  an  aviary  which  is  gradually  occupied  by  different 
kinds  of  birds,  which  correspond  to  the  varieties  of  know- 
ledge. When  we  were  children  the  aviary  was  empty, 
and  as  we  grow  up  we  go  about "  catching  "  the  various 
kinds  of  knowledge.' 

Plato  recognized,  in  the  Timcetu,  two  kmds  of  mental 
disease,  to  wit,  madness  and  ignorance.  He  has  the  notion 
advocated  by  advanced  psychologists  to-day,  that  much 
of  the  prevalent  vice  is  due  to  an  ill  disposition  of  the  body, 
and  is  involuntary ;  "  for  no  man  is  voluntarily  bad  ;  but 
the  bad  become  bad  by  reason  of  ill  disposition  of  the  body 
and  bad  education,  things  which  are  hateful  to  every  man 
and  happen  to  him  against  his  will."  '  A  fuller  discussion 
of  the  theorem  that  madness  and  the  want  of  sense  are 
the  same  is  found  in  the  Alcibiades  (II.) ;  which  is  not,  how- 
ever, one  of  the  genuine  Dialogues.  The  different  kinds 
of  want  of  sense  are  very  graphically  described : 

Socratu.  In  like  manner  men  differ  in  regard  to  want  of  senae. 
Those  who  are  moet  out  of  their  wits  we  call  "  madmen,"  while  we 
term  those  who  are  lees  far  gone  "  stupid,"  or  "  idiotic,"  or  if  we 


I  Dto^^e*,  iv.  254-5. 


Ibid.  iv.  282. 
65 


Ibid.  iu.  509. 


li 


m 


PHYSIC  AND  PHYSICIANS 

prefer  gentle  Ungnage,  deMribe  them  as  "  romantio  "  or  "  aiinple- 
minded."  or  again  aa  "  innocent,"  or  "  inexperienced,"  or  "  foolish." 
YoQ  may  even  find  other  names  if  yon  seek  for  them,  bat  by  all  of 
them  lack  of  senM  is  intended.  They  only  differ  as  one  art  appears 
to  us  to  differ  fcom  another,  or  one  'iinfmif  from  another. 

There  is  a  shrewd  remark  in  the  Republic  "that  the 
most  gifted  minds,  when  thej  are  ill-educated,  become 
pre>eminenetly  bad.  Do  not  great  crimes  and  the  spirit 
of  pure  evil  spring  out  of  a  fulness  of  nature  ruined  by 
education  rather  'han  from  any  inferiority,  whereas  weak 
natures  are  scarcel;  capable  of  any  very  great  good  or  very 
great  evil."  * 

In  the  PhcBdnu  there  is  recognized  a  form  of  madness 
"  which  is  a  divine  gift  and  a  source  of  the  chiefest  blessings 
granted  to  man."  Of  this  there  are  four  kinds— prophecy, 
inspiration,  poetry  and  love.  That  indefinable  something 
which  makes  the  poet  as  contrasted  with  th  rhymster 
and  which  is  above  and  beyond  all  art,  is  well  characterized 
in  the  following  sentence  :  "  But  he  who,  having  no  touch 
of  the  LIuse's  madness  in  his  soul,  comes  to  the  door  and 
thinks  that  he  will  get  into  the  temple  by  the  help  of  art- 
he,  I  say,  and  his  poetry  are  not  admitted.  The  sane  man 
disappears  and  is  nowhere  when  he  enters  into  rivalry  with 
a  madman." '  Certain  crimes,  too,  are  definitely  recog- 
nized as  manifestations  of  insanity ;  in  the  Laws  the  in- 
curable criminal  is  thus  ac'.lressed :  "  Oh,  sir,  the  'mpulse 
which  moves  you  to  rob  temples  is  not  an  ordinary  human 
malady,  nor  yet  a  visitation  of  heaven,  but  a  madness 

>  Dialogutt,  iii.  189. 

'  Ibid.  i.  450-1 ;  "  Not  by  wisdom  do  poets  write  poetry,  but  by 
a  sort  of  insplraticm  and  gemm."— Apology. 

66 


AS  DEPICTED  IN  PLATO 

which  is  begotten  in  man  from  ancient  and  unezpiated 
crimes  of  his  race."  In  the  Laws,  too,  it  is  stated  that 
there  are  many  sorts  of  madness,  some  arising  out  of 
disease,  and  others  originating  in  an  evil  and  passionate 
temperament,  and  are  increased  by  bad  education.  Re- 
specting the  care  of  the  insane,  it  is  stated  that  a  madman 
shall  not  be  at  large  in  the  city,  but  his  relations  shall  keep 
him  at  home  in  any  way  they  can,  or  if  not,  certain  fines 
are  irsntioned.^ 

The  greatest  aid  in  the  prevention  of  disease  is  to  pre- 
serve the  due  proportion  of  mind  and  body,  "  for  there  is 
no  proportion  or  disproportion  more  productive  of  health 
and  disease,  and  virtue  and  vice,  than  that  between  soul 
and  body."  In  the  double  nature  of  the  living  being  if 
there  is  in  this  compound  an  impassioned  soul  more  power- 
ful than  the  body,  "that  soul,  I  say,  convulses  and  fills 
with  disorders  tho  whole  inner  nature  of  man ;  and  when 
eager  in  the  pursuit  of  some  sort  of  learning  or  study, 
causes  wasting ;  or  again,  when  teaching  or  disputing  in 
private  or  in  public,  and  con»iderations  and  controversies 
arise,  inflames  and  dissolve?  the  composite  form  of  man 
and  introduces  rheums ;  and  the  nature  of  this  pheno- 
menon is  not  understood  by  most  professors  of  medicine, 
who  ascribe  it  to  the  opposite  of  the  real  cause."  .  .  . 
Body  and  mind  should  both  be  equally  exercised  to  pro- 
tect against  this  disproportion,  and  "  we  should  not  move 
the  body  without  the  soul  or  the  soul  without  the  body. 
In  this  way  they  will  be  on  their  guard  against  each  other, 
and  be  healthy  and  well  balanced."    He  urges  the  mathe- 


>  Dtofa^nM,  ▼.  236,  323.  394. 
67 


i 


PHYSIC  AND  PHYSiaANS 

matician  to  practise  gymnastic,  and  the  gymnast  to  culti- 
vate music  and  philosophy/ 

The  modes  of  treatment  advised  are  simple,  and  it  is 
evident  that  Plato  had  not  much  faith  in  medicines.  Pro- 
fessor Jowett's  commentary  is  here  worth  quoting :  "  Plato 
is  stm  the  enemy  of  the  purgative  treatment  of  physicians, 
which,  except  in  extreme  cases,  no  man  of  sense  will  ever 
adopt.  For,  as  he  adds,  with  an  insight  into  the  truth, 
'  every  disf>a8e  is  akin  to  the  nature  of  the  living  being  and 
is  only  irritated  by  stimulants.'  He  is  of  opinion  that 
nature  should  be  left  to  herself,  and  is  inclined  to  think 
tiiat  physicians  are  in  vain  (cp.  Laws,  VI.  761  C,  where  he 
says  that  warm  baths  would  be  more  beneficial  to  the 
limbs  of  the  aged  rustic  than  the  prescriptions  of  a  not 
overwise  doctor).  If  he  seems  to  be  extreme  in  his  con- 
demnation of  medicine  and  to  rely  too  much  on  diet  and 
exercise,  he  might  appeal  to  nearly  all  the  best  physicians 
of  our  own  age  in  support  of  his  opinions,  who  often  &peak 
to  their  patients  of  the  worthlessness  of  drugs.  For  we 
ourselves  are  sceptical  about  medicine,  and  very  unwilling 
to  submit  to  the  purgative  treatment  of  physicians.  May 
we  not  claim  for  Plato  an  anticipation  of  modem  ideas  as 
about  some  questions  of  astronomy  and  ph3rsics,  so  also 
about  medicine  ?  As  in  the  Charmides  (156,  7)  he  tells  us 
thbt  the  body  cannot  be  cured  without  the  soul,  so  in  the 
TimcBiu  he  strongly  asserts  the  sympathy  of  soul  and 
body ;  any  defect  of  either  is  the  occasion  of  the  greatest 
discord  and  disproportion  in  the  other.  Here  too  may  be 
a  presentiment  that  in  the  medicine  of  the  future  the  in- 
terdependence of  mind  and  body  will  be  more  fully  recog- 

*  Ditdoguea,  iii.  010-1. 
68 


AS  DEPICTED  IN  PLATO 

nized,  and  that  the  influence  of  the  one  over  the  other 
may  be  exerted  in  a  manner  which  is  not  now  thought 
possible."  * 

The  effect  of  the  purgative  method  to  which  Plato  was 
so  opposed  is  probably  referred  to  in  the  following  passage. 
"  When  a  man  goes  of  his  own  accord  to  a  doctor's  shop 
and  takes  medicine,  is  lie  not  quite  aware  that  soon  and 
for  many  days  afterwards,  he  will  be  in  a  state  of  body 
which  he  would  rather  die  than  accept  as  a  permanent 
condition  of  his  life  1 " 

It  is  somewhat  remarkable  that  nowhere  in  the  Dialogue$ 
is  any  reference  made  to  the  method  of  healing  at  the 
.^Bsculapian  temples.  The  comments  upon  physic  and 
physicians  are  made  without  allusion  to  these  institutions. 
Hippocrates  and  other  practitioners  at  Athens  were  pro* 
bably  secilar  Asclepiads,  but  as  Dyer  remarks,  "  in  spite 
of  the  severance  the  doctors  kept  in  touch  with  the  wor- 
ship of  iEsculapius,  and  the  priests  in  his  temples  did  not 
scorn  such  secular  knowledge  aa  they  could  gain  from  lay 
practitioners.* 

II 

So  much  for  the  general  conception  of  the  structure  and 
functions  of  the  body,  in  order  and  disorder,  as  conceived 
by  Plato.  Were  nothing  more  to  be  gleaned,  the  thoughts 
on  these  questions  of  one  of  the  greatest  minds  of  what 
was  intellectually  the  most  brilliant  period  of  the  race, 
would  be  of  interest,  but  scattered  throughout  his  writings 
are  innumerably  little  chUer  dicta,  which  indicate  a  pro* 
foimd  knowledge  of  that  side  of  human  nature  which  turns 

>  Dialogues,  Ui.  413.  *  The  Gods  of  Greece. 

59 


!  I 


PKYSIC  AND  PHYSICIANS 

nppennoBt  when  the  machinery  is  oat  of  gear.  There  are, 
in  addition,  many  charming  analogies  drawn  from  medicine, 
and  many  acute  suggestions,  some  of  which  have  a  modem 
flavour.  The  noble  pilot  and  the  wise  phjrsician  who,  as 
Nestor  remarks,  "is  worth  many  another  man,"  furnish 
some  of  the  most  striking  illustrations  of  the  Dialogves. 

One  oi  the  most  admirable  definitions  of  the  Art  of 
Medicine  I  selected  as  a  rubric  with  which  to  grace  my 
text-book,  "  And  I  said  of  medicme,  that  this  is  an  Art 
which  considers  the  constitution  of  the  patient,  and  has 
principles  of  action  and  reasons  in  each  case."  Or,  again, 
the  comprehensive  view  taken  in  the  statement,  "There 
is  one  science  of  medicine  which  is  concerned  with  the 
inspection  of  health  equally  in  all  times,  present,  past  and 
future." 

Plato  gives  a  delicious  account  of  the  origin  of  the 
modem  medicine,  as  contrasted  with  the  art  of  the  guild 
of  Asclepius.  ^ 

Well,  I  said,  and  to  require  the  help  of  medicme,  not  when  a 
vround  has  to  be  cored,  or  on  occasion  of  an  epidemic,  but  just 
because  by  indolence  and  a  habit  of  life  such  as  we  have  bem 
describing,  men  fill  themselves  with  waters  and  winds,  as  if  their 
bodies  were  a  marsh,  compelling  the  ingenious  sons  of  Asclepius 
to  find  more  names  for  diseases,  such  as  flatulence  and  catarrh ; 
is  not  this,  too,  a  di^;race  ? 

Yea,  he  said,  they  do  certainly  give  very  strange  and  new-fangled 
names  to  diseases. 

Yes,  I  said,  and  I  do  not  believe  there  were  any  such  diseases  in 
the  days  of  Asclepius ;  and  this  I  infer  from  the  circumstance  that 
the  hero  Eurypylus,  after  he  has  been  wounded  in  Homer,  drinks 
a  posset  of  Pramnian  wine  well  besprinkled  with  barley-meal  and 
grated  cheese,  which  are  certainly  inflammatory,  and  yet  the  sons  of 
Asclepius  who  were  at  the  Trojan  war  do  not  blame  the  damsel 

*  Dialogues,  iii.  93. 
60 


AS  DEnCTED  IN  PLATO 
who  givM  him  the  drink,  or  raboke  Pfttrooloi,  who  is  treating  his 


Well,  he  Mkid,  that  was  surely  an  extraordinary  drink  to  be  given 
to  a  person  in  his  condition. 

Not  80  extraordinary,  I  replied,  if  you  bear  in  mind  that  in  former 
days,  as  u  commonly  said,  before  thetimeof  Herodicu8,th€V£uildof 
Asclepius  did  not  practise  our  present  system  of  medicine,  which 
may  be  said  to  educate  diseases.  But  Herodicus,  being  a  trainer, 
and  himself  of  a  sickly  constitution,  by  a  combination  of  training 
and  doctoring  found  out  a  way  of  torturing  first  and  chiefly  iximself, 
and  secondly  the  rest  of  the  world. 

How  was  that  ?  he  said. 

By  the  invention  of  lingering  death  ;  for  he  had  a  mortal  disease 
which  he  perpetually  tended,  and  as  recovery  was  out  of  the  ques- 
tion, he  passed  his  entire  life  as  a  valetudinarian ;  he  could  do 
nothing  but  attend  upon  himself,  and  he  was  in  constant  torment 
whenever  he  departed  in  anything  from  his  usual  regimen,  and  so 
djnng  hard,  by  the  help  of  science  he  struggled  on  to  old  age. 

A  rare  rewaxd  of  his  skill  1 

He  goes  on  to  say  that  Asclepius  did  not  instruct  his 
descendants  in  valetudinarian  arts  because  he  knew  that 
in  well-ordered  states  individuals  with  occupations  had 
no  time  to  be  ill.  If  a  carpenter  falls  sick,  he  asks  the 
doctor  for  a  "rough  and  ready  cure — ^an  emetic,  or  a 
purge,  or  a  cautery,  or  the  knife — ^these  are  his  remedies." 
Should  any  one  prescribe  for  him  a  course  of  dietetics 
and  tell  him  to  swathe  and  swaddle  his  head,  and  all  that 
sort  of  thing,  he  says,  **  he  sees  no  good  in  a  life  spent  in 
nursing  his  disease  to  the  neglect  of  his  customary  employ- 
ment ;  and  therefore  bidding  good-bye  to  this  sort  of 
physician,  he  resumes  his  ordinary  habits,  and  either  gets 
well  and  lives  and  does  his  business,  or,  if  his  constitution 
fails,  he  dies  and  has  no  more  trouble."  ^ 

He  is  more  in    unest  in  another  place  (Oorgiaa)  in  an 

*■  Dialoguu,  iii.  93-4. 
61 


j;   ) 


PHYSIC  AND  PHYSICIANS 

•ocoont  of  the  reUtionB  of  the  arte  of  medicine  and  gym> 
nasties:  "The  soul  and  the  body  being  two,  have  two 
arte  corresponding  to  them :  there  is  the  art  of  politics 
attending  on  the  soul ;  and  another  art  attending  on  the 
body,  of  which  I  know  no  specific  name,  but  which  may 
be  described  as  having  two  divisions,  one  of  them  gym- 
nastic, and  the  other  medicine.  And  in  politics  there  is 
a  legislative  part,  which  answers  to  gymnastic,  as  justice 
does  to  medicine  ;  and  the  two  parts  run  into  one  another, 
justice  having  to  do  with  the  same  subject  as  legislation, 
and  medicine  with  the  same  subject  as  g3rmnastic,  but 
with  a  difference.  .  .  .  Cookery  simulates  the  disguise  of 
medicine,  and  pretends  to  know  what  food  is  the  best  for 
the  body ;  and  if  the  ph3rsician  and  the  cook  had  to  enter 
into  a  competition  in  which  children  were  the  judges,  or 
men  who  had  no  more  sense  than  chTdren,  as  to  which  of 
them  best  understands  the  goodness  or  badness  of  food, 
the  physician  would  be  starved  to  death."  ^ 

And  later  in  the  same  dialogue  Socrates  claims  to  be  the 
only  true  politician  of  his  time  who  speaks,  not  with  any 
view  of  pleasing,  but  for  the  good  of  the  State,  and  is  un- 
willing to  practise  the  graces  of  rhetoric — ^and  so  would 
make  a  bad  figure  in  a  court  of  justice.  He  says :  "  I 
shall  be  tried  just  as  a  physician  would  be  tried  in  a  court 
of  little  boys  at  the  indictment  of  the  cook.  What  would 
he  reply  under  such  circumstances,  if  some  one  were  to 
accuse  him,  sayiug,  '  0  my  boys,  many  evil  things  has 
this  man  done  to  you ;  he  is  the  death  of  you,  especially  of 
the  younger  ones  among  you,  cutting  and  burning  and 
starving  and  suffocating  you,  until  you  know  not  what  to 

*■  Dialogues,  ii.  345-6. 
62 


AS  DEPICTED  IN  PLATO 

do;  he  gives  70a  the  bitterest  potions,  and  compels  you 
to  hunger  and  fast  ?  How  unlike  the  variety  of  meats 
and  sweets  on  which  I  feasted  for  you.*  What  do  you 
suppose  that  the  phjrsician  would  be  able  to  reply  when  he 
found  himself  in  such  a  predicament?  If  he  told  the 
truth  he  could  only  say :  '  All  these  evil  things,  my  bojrs 
I  did  for  your  health,'  and  then  would  there  not  just  be  a 
clamour  among  a  jury  like  that  1  Hew  they  would  cry 
out ! "  * 

The  principle  of  continuity,  of  uniformity,  so  striking 
in  ancient  physics  was  transferred  to  the  body,  which,  like 
the  world,  was  conceived  as  a  whole.  Several  striking 
passages  illustrative  of  this  are  to  be  found.  Thus  to  the 
question  of  Socrates,  "  Do  you  think  that  you  can  know 
the  nature  of  the  soul  intelligently  without  knowing  the 
nature  0!  the  whole  ?  "  Phaedrus  replies,  "  Hippocrates, 
the  Aflclepiad,  says  that  the  nature  even  of  the  body  can 
only  be  understood  as  a  whole."  *  The  importance  of 
treating  the  whole  and  not  the  part  is  insisted  upon.  In 
the  case  of  a  patient  who  comes  to  them  with  bad  eyes 
the  saying  is  "  that  they  cannot  cure  his  eyes  by  them- 
selves, but  that  if  his  eyes  are  to  be  cured  his  head  must  be 
treated " :  and  then  again  they  say  "  that  to  think  of 
curing  the  head  alone  and  not  the  rest  of  the  body  also  is 
the  height  of  folly." 

Charmides  had    been  complaining  of  a  headache,  and 

Critiaii  had  asked  Socrates  to  make  believe  that  he  could 

cure  him  of  it.    He  said  that  he  had  a  charm,  which  he 

had  learnt,  when  serving  with  the  army,  of  one  of  the 

physicians  of  the  Thracian  king,  Zamobds.    This  physi- 

^  Dialoguea,  ii.  415.  *  Ibid.  i.  479. 

68 


. 


(  t 


W': 


PHYSIC  AND  PHYSICIANS 

cun  had  told  Soontet  that  the  cuie  of  the  part  shotdd  not 
be  attempted  without  treatment  of  the  whole,  and  aUo 
that  no  attempt  should  be  made  to  cure  the  body  without 
the  soul,  "  and,  therefore,  if  the  head  and  body  are  to  be 
well  you  must  begin  by  curing  the  soul ;  that  is  the  first 
thing.  .  .  .  And  he  who  taught  me  the  cure  and  the  charm 
added  a  special  direction,  '  Let  no  one,'  he  said, '  persuade 
you  to  cure  the  head  until  he  has  first  given  you  his  soul  to 
be  cured.  For  this,'  he  said, '  is  the  great  enor  of  our  day 
in  the  treatment  of  the  human  body,  that  physicians  sepa- 
rate the  soul  from  the  body.' "  The  charms  to  which  he 
referred  were  fair  words  by  which  temperance  was  im- 
planted in  the  soul.' 

Though  a  contemporary,  Hippocrates  is  only  once  again 
referred  to  in  the  Dialogues— wlieie  the  young  Hippocrates, 
son  of  Apollodorus,  who  has  come  to  Protagoras,  "  that 
almighty  wise  man,"  as  Socrates  terms  him  in  another 
place,  to  learn  the  science  and  knowledge  of  human  life, 
is  asked  by  Socrates,  "  If  you  were  going  to  Hippocrates 
of  Cos,  the  Asdepiad,  and  were  about  to  give  him  your 
money,  and  some  one  had  said  to  you,  '  You  are  paying 
money  to  your  namesake,  Hippocrates,  0  Hippocrates; 
U\\  me,  what  is  he  that  you  give  him   money?'  how 
would  you  have  answered  ?  "    "I  should  say,"  he  replied, 
"  that  I  gave  money  to  him  as  a  physician."    "  And  what 
will  he  make  of  you?"     "A  physician,'    he  said'— a 
paragraph  which  would  indicate  that  Hippocrates  was  in 
the  habit  of  taking  pupils  and  teaching  them  the  art  of 
medicine ;  and  m  the  Euthydemus,  with  reference  to  the 
education  ol  physicians,  Socrates  sap,  "that  he  would 
»  Dialogues,  L  11-13.  '  Ibid.  I  131-2. 

G4 


AS  DEPICTED  IN   PLATO 

send  such  to  those  who  profess  the  art,  and  to  those  who 
demand  payment  for  teaching  the  art,  and  profess  to 
teach  it  to  any  c  a  who  will  come  and  learn." 

We  get  a  glimpse  of  the  method  of  diagnosis,  derived 
doubtless  from  personal  observation,  possibly  of  the  great 
Hippocrates  himself,  whose  critical  knowledge  of  pdmo* 
nary  complaints  we  doily  recognize  in  the  use  of  his  name 
in  association  with  the  clubbed  fingers  of  phthisis,  and 
with  the  succuBsion  splash  of  pneumo-thorax.  "  Suppose 
some  one,  who  is  inquiring  into  the  health  or  some  other 
bodily  quality  of  another :  he  looks  at  his  face  and  at  the 
tips  of  his  fingers,  and  then  he  says,  '  Uncover  your  chest 
and  back  to  me  that  I  may  have  a  better  view.'  "  And  then 
Socrates  says  to  Protagoras,  "  Uncover  your  mind  to  me ; 
reveal  your  opinion,  etc."  * 

One  of  the  most  celebrated  medical  passages  is  that  in 
which  Socrates  professes  the  art  of  a  midwife  practising  on 
the  souls  of  men  when  they  are  iii  labour,  and  diagnosing 
their  condition,  whether  pregnant  with  the  truth  or  with 
with  some  "  darling  folly."  The  entire  section,  though 
long,  must  be  quoted,  Socrates  is  in  one  of  his  "littie 
difficulties  "  and  wishes  to  know  of  the  young  The»tetus, 
who  has  been  presented  to  him  as  a  paragon  of  learning, 
and  whose  progress  in  the  path  of  knowledge  has  been  sure 
and  smooth—"  flowing  on  silently  like  a  river  of  oil  " — 
what  is  knowledge  ?  Thesetetus  is  soon  entangled  and 
cannot  shake  off  a  feeling  of  anxiety. 

Theat.  I  can  assure  you,  Socrates,  that  I  have  tried  very  often, 
when  the  report  of  questions  asked  by  you  was  brought  to  me ; 
but  I  can  neither  persuade  mymU  that  I  have  any  answer  to  give. 


AK. 


*  Dialogues,  i.  176. 
65 


PHYSIC  AND  PHYSICIANS 

nor  hMT  of  any  one  who  tat^mn  ai  you  would  h»v»  turn ;  Mtd  I 
eMiDOt  abake  off  »  feoliog  of  uudety. 

Soe.  TheM  u«  the  puige  of  Ubour.  my  dear  Tbeatetoe ;  yoa 
hare  loiDethiiig  within  yoa  which  you  are  bringing  to  the  birth. 

JlUot.    I  do  not  know,  Sooratet ;  I  only  eay  what  I  fecL 

Soe.  And  did  you  never  hear,  simpleton,  that  I  am  the  eon  of 
•  midwife,  brave  and  burly,  whoee  name  waa  Phanarete  T 

Themt.    Yea,  I  have. 

Soc.    And  that  I  myaelf  praotiae  midwifery  T 

Themt.    No,  never.  ._,    j    ,_. 

Soc  Let  me  tell  you  that  I  do  though,  my  friend ;  bat  you 
muat  not  reveal  the  aecret,  aa  the  world  in  general  have  not  found 
me  out ;  and  therefore  they  only  aay  of  me.  that  I  am  the  atrangeat 
of  morula,  and  drive  men  to  their  wits'  end.  Did  you  ever  hear 
that  too? 
ThtcBt.    Yea. 

Soe.    Shall  I  tell  you  the  reaaon  ? 
Theat.    Byallmeana. 

Soc.    Bear  in  mind  the  whole  busineea  of  the  midwivea.  and  then 
you  will  aee  my  meaning  better.    No  woman,  aa  you  an?  probably 
aware,  who  ia  atill  able  to  conceive  and  bear,  attends  other  women, 
but  only  those  who  are  past  bearing. 
Theat.    Yes,  I  know. 

Soe.  The  reason  of  this  is  said  to  be  that  Artemis— the  goddess 
of  chUdbirth— is  not  a  mother,  and  she  honours  those  who  are  like 
herself ;  but  she  could  not  allow  the  barren  to  be  midwivne,  because 
human  nature  cannot  know  the  mystery  of  an  art  without  ex- 
penence ;  and  therefore  she  asugned  this  oflSce  to  those  who  are 
too  old  to  hear. 
Theat.    I  dare  say. 

Soc.    And  I  dare  aay,  too,  or  rather  I  am  absolutely  certam. 
that  the  midwivea  know  better  than  others  who  ia  pregnant  and 
who  is  not  T 
Theat.    Very  true. 

Soe.    And  by  the  use  of  potions  and  incantations  they  are  able 
to  arouse  the  pangs  and  to  soothe  them  at  will ;  they  can  make 
tnoee  bear  who  have  a  difficulty  in  bearing,  and  if  they  think  fit, 
they  can  smother  the  embryo  in  the  womb. 
Thecel.    They  can. 

Soc.  Did  you  ever  remark  that  they  are  also  most  cunning 
matchmakers,  and  have  a  thorough  knowledge  of  what  unions  are 
likely  to  produce  a  brave  brood  T 

66 


AS   DEPICTED   IN   PLATO 


TJkMif.    No,  DOTMr. 

Soe.  Then  l«t  me  toll  you  tb*t  thi#  in  tbeir  gr<«l>  st  pride,  mon 
than  outtiog  the  umbilical  cord.  Aiid  f  you  iwtlect,  jroa  wiU  see 
th»l  the  Mune  art  whica  cultivates  md  gat  hen  in  tb<  f.*<iit4ioi  the 
earth,  will  be  most  likely  to  know  in  what  »o:\a  the  M^.eral  pl&nte 
or  seeds  should  be  deposited. 

Theai.    Yes,  the  same  art. 

iSo^.    And  do  you  suppose  that  with  women  ilu-  csm  u  otiierwise. 

Theat.    I  should  think  not. 

Soc.  v^rtainly  not;  but  midwives  are  respectable  w^men  and 
have  a  character  to  lose,  anH  they  avoid  this  department  of  their 
profeaBian,  because  they  are  afraid  of  being  oali«d  prooureases, 
which  is  a  name  given  to  those  who  join  together  man  and  woman 
in  an  unlawful  and  unscientific  way ;  and  v  !>t  the  true  midwife  is 
also  the  true  and  only  matchmaker. 

Theat.    Clearly. 

Soe.  Such  are  the  midwivoH.  whoso  task  it*  a  very  important 
one,  but  not  so  important  as  mine ;  for  wooion  do  not  bring  into 
the  world  at  one  time  real  children,  and  at  another  time  counter- 
feits which  are  with  difficulty  distinguished  from  them ;  if  they 
did,  then  the  discernment  of  the  true  and  false  birth  would  be  the 
crowning  achievement  of  the  art  of  midwifery — you  would  think 
so? 

Theat.    Indeed  I  should. 

Soe.  WeH.  my  art  of  midwifery  is  in  most  respects  like  theirs ; 
but  differs  in  that  I  attend  men  and  not  women,  and  I  look  after 
their  souls  when  they  are  in  labour,  and  not  after  their  bodies; 
and  the  triumph  of  i  ny  art  is  in  thoroughly  examining  whether  the 
thought  which  the  mind  of  the  young  man  is  bringing  to  the  birth, 
is  a  false  idol  or  a  noble  and  true  birth.  And  like  the  midwives, 
I  am  barren,  and  the  reproach  which  is  often  made  against  me, 
that  I  ask  questions  of  others  and  have  not  the  wit  to  answer  them 
myself,  is  very  just ;  the  reason  '«,  that  the  god  compels  me  to  bo 
a  midwife,  but  forbids  me  to  brit:g  forth.  And  therefore  I  am  not 
mjTself  at  all  wise,  nor  have  I  anything  to  show  which  is  the  inven- 
timi  or  birth  of  my  own  soul,  but  those  who  converse  with  me 
profit.  Some  of  them  appear  dull  enough  at  first,  but  afterwards, 
as  our  acquaintance  ripens,  if  the  god  is  gracious  to  them,  they  all 
make  astonishing  progress ;  and  this  in  the  opinion  of  othe.fi  as 
well  as  their  own.  It  .d  quite  clear  that  they  had  never  learned 
anything  from  me ;  the  many  fine  discoveries  to  which  they  cUng 
are  of  thdr  own  making.    But  to  me  and  the  god  thay  owe  their 

67 


PHYSIC  AND  PHYSICIANS 


1 


delivery.    And  the  proof  of  my  words  is,  that  many  of  them  in 
their  ignorance,  either  in  their  self-oonoeit  despising  me,  or  falling 
under  the  influence  of  others,  have  gone  away  too  soon ;  and  have 
not  only  loat  the  children  of  whom  I  had  previously  delivered  them 
by  an  ill  bringing  up,  but  have  stifled  whatever  else  they  had  in 
them  by  evil  oommunicatioiiis,  being  fonder  of  lies  and  shams  than 
of  the  truth ;  and  they  have  at  last  ended  by  seeing  themselves, 
as  others  see  them,  to  be  great  fools.   Aristeidee,  the  son  of  Lysi- 
maohus,  is  one  of  them,  and  there  are  many  others.    The  truants 
often  return  to  me,  and  beg  that  I  would  ronsort  with  them  again 
—they  are   ready   to  go  to  mo   on   their  knees — and  then,    if 
my  familiar  allows,  which  is  not  always  the  case,  I  receive  them 
and  they  begin  to  grow  again.     Dire  are  the  pangs  which  my  art 
is  able  to  arouse  and  to  allay  in  those  who  consort  with  me,  just 
like  the  pangs  of  women  in  childbirth  ;  night  and  day  they  are  full 
of  perplexity  and  travail  which  is  even  worse  than  that  of  the 
women.    So  much  for  them.     And  there  are  others.  Thesetetus, 
who  come  to  me  apparently  having  nothing  in  them  ;  and  as  I 
know  that  they  have  no  need  of  my  art.  I  coax  them  into  marrying 
some  one,  and  by  the  grace  of  God  I  can  generally  tcU  who  is  likely 
to  do  them  good.     Many  of  them  I  have  given  away  to  Prodicus, 
and  many  to  other  inspired  sages.    I  tell  you  this  long  story,  friend 
Theetetns,  because  I  suspect,  as  indeed  yuu  seem  to  think  yourself, 
that  you  are    in    labour— great    with   some    conception.     Come 
then  to  me,  w'.o  am  a  midwife's  son  and  myself  a  midwife,  and  try 
to  answer  the  questions  which  I  will  ask  you.    And  if  I  abstract 
and  expose  your  tirst-bom,  i;ecau8e  I  discover  upon  inspection  that 
the  con  eption  which  you  have  formed  is  a  vain  shadow,  do  not 
quarrel  with  me  on  that  account,  as  the  manner  of  women  is  when 
their  first  children  are  taken  from  them.    For  I  have  actually 
known  some  who  were  ready  to  bite  me  when  I  deprived  them  of 
a  darling  folly  ;  they  did  not  perceive  that  I  acted  from  good  will, 
not  knowing  that  no  god  is  the  enemy  of  man— that  was  not  within 
the  range  of  their  ideas ;  neither  am  I  their  enemy  in  all  this,  but 
it  would  be  wrong  in  me  to  admit  falsehood,  or  to  stifle  the  truth. 
Once  more,  then,  Thetetetus,  I  repeat  my  old  question,  "  What  ia 
knowledge  T  "  and  do  not  say  that  you  cannot  tell ;  but  quit  your- 
self like  a  man,  and  by  the  help  of  God  you  will  be  able  to  telL* 

Socrates  proceeds  to  determine  whether  the  intellectual 

^  Dialoguu,  iv.  201-4. 

68 


AS  DEPICTED  IN  PLATO 
babe  brought  forth  by  TheatetuB  is  a  wind-egg  or  a  real 
and  genuine  birth.  "  This  then  is  the  child,  however  he 
may  turn  out,  which  you  and  I  have  with  difficulty  brought 
into  the  world,  and  now  that  he  is  bom  we  must  run  round 
the  hearth  with  him  and  see  whether  he  is  worth  rearing 
or  only  a  wind-egg  and  a  sham.  Is  he  to  be  reared  m  any 
case  and  not  exposed  ?  or  will  you  bear  to  see  him  rejected 
and  not  get  into  a  passion  if  I  take  away  your  firs^bom  ?  " 
The  conclusion  is  "  that  you  have  brought  forth  wind,  and 
that  the  offspring  of  your  brain  are  not  worth  bringing  up." 
And  the  dialogue  ends  as  it  began  with  a  reference  to  the 
midwife  :  "  The  office  of  a  midwife  I,  like  my  mother,  have 
received  from  God ;  she  delivered  women,  and  I  deliver 
men  ;  but  they  must  be  young  and  noble  and  fair." 

Ill 

From  the  writings  of  Plato  we  may  gather  many  details 
about  the  status  of  physicians  in  his  time.  It  is  very 
evident  that  the  profession  was  far  advanced  and  had  been 
progressively  developing  for  a  long  period  before  Hippo- 
crates, whom  we  erroneously,  yet  with  a  certain  propriety, 
call  the  Father  of  Medicine.  The  Little  by-play  between 
Socrates  and  Euthydemus  suggests  an  advanced  condition 
of  medical  literature  :  "  Of  course,  you  who  have  so  many 
books  are  going  in  for  being  a  doctor,"  says  Socrates,  and 
then  he  adds,  "  there  are  so  many  books  on  medicine,  you 
know."  As  Dyer  remarks,  whatever  the  quality  of  these 
books  may  have  been,  their  number  must  have  been  great 
to  give  point  to  this  chaff. 

It  may  be  cleany  gathered  from  the  writings  of  Plato 
that  two  sorts  of  physicians  (apart  altogether  from  quacks 

69 


'H' 


Ml 


U 


PHYSIC  AND  PHYSICIANS 

and  the  iEBCukpian  guild)  existed  in  Athens,  the  private 
practitioner,  and  the  State-physician.    The  latter,  though 
the  smaller  numerically,  representing  apparently  the  moat 
distinguished  class.    From  a  reference  in  one  of  the  dia- 
logues {Gorgias)  they  evidently  were  elected  by  public 
aggembly,— "  when  the  assembly  meets  to  elect  a  physi- 
cian."*     The  office  was  apparently  yearly,  for  in  the 
SUxteman  is  the  remark,  "when  the  year  of  office  has 
expired,  the  pilot  or  physician  has  to  come  before  a  court 
of  review  "  to  answer  any  charges  that  may  be  made  against 
him.    In  the  same  dialogue  occurs  the  remark,  "  and  if 
anyone  who  is  in  a  private  station  has  the  art  to  advise 
one  of  the  public  physicians,  must  he  not  be  called  a  physi- 
cian ? " '     Apparently  a  physician  must  have  been  in 
practice  for  some  time  and  attained  great  eminence  before 
he  was  deemed  worthy  of  the  post  of  State-physician. 
"  If  you  and  I  were  physicians,  and  were  advising  one 
another  that  we  were  competent  to  practise  as  state-physi- 
cians, should  I  not  ask  you,  and  would  you  not  ask  me, 
Well,  but  how  about  Socrates  himself,  has  he  good  health  ? 
And  was  any  one  else  ever  known  to  be  cured  by  him 
whether  slave  or  freeman  ?  "  ' 

A  reference  to  the  two  sorts  of  doctors  is  also  found  in 
the  Republic :  "  Now  you  know  that  when  patients  do 
not  require  medicine,  but  have  only  to  be  put  under  a 
regimen,  the  inferior  sort  of  practitioner  is  deemed  to  be 
good  enough ;  but  when  medicine  has  to  be  given,  then 
the  doctor  should  be  more  of  a  man."  * 
The  office  of  State-physician  was  in  existence  fully  two 

»  Dialogues,  il.  335.  Ibid.  iv.  453.  502.        »  Ibid.  ii.  407. 

«  !b  ii.  Hi.  153. 
70 


AS  DEPICTED   IN    PLATO 

generations  before  this  time,  for  Democedes  held  this  post 
at  Athens  in  the  second  half  of  the  sixth  century  at  a  salary 
of  £406,  and,  very  much  as  a  modem  professor  might  be, 
he  Tfas  seduced  away  by  the  offer  of  a  great  increase  in 
"lalary  by  Polycrates,  the  tyrant  of  Samos.  It  is  evident, 
too,  from  the  Laws,  that  the  doctors  had  assistants,  often 
among  the  slaves. 


For  of  doctors,  as  I  may  remind  you,  some  have  a  gentler,  other* 
a  ruder  method  of  euro ;  and  as  children  ask  the  doctor  to  be  gentle 
with  them,  so  we  will  ask  the  legislator  to  cure  our  disorders  with 
the  gentlest  remedies.  Wliat  I  mean  to  say  is,  that  besides  doctors 
there  are  doctors'  servants,  who  are  also  styled  doctors. 

Cle.    Very  true. 

(Eth.  And  whether  they  are  slaves  or  freemen  makes  no  differ- 
ence ;  they  acquire  their  knowledge  of  medicine  by  obeying  and 
observing  their  masters ;  empirically  and  not  according  to  the 
natural  way  of  learning,  as  the  manner  of  freemen  •is,  who  have 
learned  scientifically  themselves  the  art  which  they  impart  scien- 
tifically to  their  pupils.  You  are  aware  that  there  are  these  two 
classes  of  doctors  ? 

Cle.    To  bo  sure. 

(Eth.  And  did  you  ever  observe  that  thei«  are  two  classes  of 
patients  in  states,  slaves  and  freemen ;  and  the  slave  di)ctore  run 
about  and  cure  the  slaves,  or  wait  for  them  in  the  dispensaiies — 
practitioners  of  this  sort  never  talk  to  their  patients  individually, 
or  let  them  talk  about  their  own  individual  complaints  ?  The 
slave-doctor  prescribes  what  mere  experience  suggests,  as  if  he  had 
oxact  knowledge ;  and  when  he  has  given  his  orders,  like  a  tyrant, 
he  rushes  off  with  equal  assurance  to  some  other  servant  who  is  ill ; 
and  so  he  relieves  the  master  of  the  hotise  of  the  care  of  his  invalid 
slaves.  But  the  other  doctor,  who  is  a  frecirar.,  attends  and 
practises  upon  freemen  ;  and  he  carries  his  inquinvH  far  back,  and 
goes  into  the  nature  of  the  disorder ;  he  enters  into  liscourso  with 
the  patient  and  with  his  friends,  and  is  at  once  getting  information 
from  the  sick  man,  and  also  instructing  him  as  far  as  he  is  able,  and 
he  will  not  prescribe  for  him  until  ho  has  first  convinced  him  ; 
at  h-M,  when  he  has  hmuKlit  tin-  patient  more  and  more  under  his 
IMrsuasive  inllucaces  ami  sot  tiini  on  the  mad  to  health,  he  attempts 

71 


\l 


ii 


If  Ji 


PHYSIC  AND  PHYSICIANS 

to  effect  a  onre.  Now  which  is  the  better  way  of  proceeding  in  • 
physician  and  in  a  trainer  ?  Is  he  the  better  who  aocompUshea 
his  ends  in  a  double  way,  or  he  who  works  in  one  way,  and  that  the 
ruder  and  inferior  ?  ^ 

This  idea  of  first  convincing  a  patient  by  argument  is 
also  mentioned  in  the  Oorgitu,  and  would  appear  indeed 
to  have  furnished  occupation  for  some  of  the  numerous 
sophists  of  that  period.  Gorgias,  lauding  the  virtues  of 
rhetoric  and  claiming  that  she  holds  imder  her  sway  all 
the  inferior  art,  says :  "  Let  me  offer  you  a  striking  ex- 
ample of  this.  On  several  occasions  I  have  been  with  my 
brother  Herodicus,  or  some  other  physician,  to  see  one  of 
his  patients,  who  would  not  allow  the  physician  to  give 
him  medicine  or  apply  the  knife  or  hot  iron  to  him ;  and 
I  have  persuaded  him  to  do  for  me  what  he  would  not  do 
for  the  physician  just  by  the  use  of  rhetoric.  And  I  say 
that  if  a  rhetorician  and  a  physician  were  to  go  to  any  city, 
and  had  there  to  argue  in  the  Ecclesia  or  any  other  assembly 
as  to  which  of  them  should  be  elected  state-physician,  the 
physician  would  have  no  chance  ;  but  he  who  could  speak 
would  be  chosen  if  he  wished."  '  In  another  place  {Laws) 
Plato  satirizes  this  custom  :  "  For  of  this  you  may  be  very 
sure,  that  if  one  of  those  empirical  physicians,  who  practise 
medicine  without  science,  were  to  come  upon  the  gentle- 
man physician  talking  to  his  gentleman  patient,  and  using 
the  language  almost  of  philosophy — beginning  at  the 
beginning  of  the  disease,  and  discoursing  about  the  whole 
nature  of  the  body,  he  would  burst  into  a  hearty  laugh — 
he  would  say  what  most  of  those  who  are  called  doctors 
always  have  at  their  tongue's  end  :  foolish  fellow,  he  would 

'  Diaioffuu,  V.  103-4.  '  Ibid.  ii.  336. 

78 


dk 


AS  DEPICTED  IN  PLATO 

wy,  you  are  not  healing  the  sick  man,  but  you  are  educa- 
ting him ;  and  he  does  not  want  to  be  made  a  doctor,  but 
to  get  weU." » 

Of  the  personal  qualifications  of  the  phjrsician  not  much 
is  said ;  but  in  the  Republic  (III.  408)  there  is  an  original, 
and  to  us  not  very  agreeable,  idea :  "  Now  the  most  skilful 
physicians  are  those  who,  from  their  youth  upwards,  have 
combined  with  a  knowledge  of  their  art,  the  greatest  ex- 
perience of  disease ;  they  had  better  not  be  in  robust 
health,  and  should  have  had  all  manner  of  diseases  m  their 
own  person.  For  the  body,  as  I  conceive,  is  not  the  in- 
strument with  which  they  cure  the  body  ;  in  that  case  we 
could  not  allow  them  ever  to  be  or  to  have  been  sickly ; 
but  they  cure  the  body  with  the  mind,  and  the  mind  which 
has  become  and  is  sick  can  cure  nothing."  ' 

Some  idea  of  the  estimate  which  Plato  put  on  the  phjrsi- 
cian  may  be  gathered  from  the  mystical  account  in  the 
Phcedrua  of  the  natiire  of  the  soul  and  of  life  in  the  upper 
world.  We  are  but  animated  failures — the  residua  of  the 
souls  above,  which  have  attained  a  vision  of  truth,  but 
have  fallen  "  hence  beneath  the  double  load  of  forgetful- 
ness  and  vice."  There  are  nine  grades  of  human  existence 
into  which  these  souls  may  pass,  from  that  of  a  philosopher 
or  artist  to  that  of  a  tjrrant.  The  phjrsician  or  lover  of 
gymnastic  toils  comes  in  the  fourth  class.' 

But  if  Plato  assigns  the  physician  a  place  in  the  middle 
tier  in  his  mystery,  he  welcomes  him  socially  into  the 
most  select  and  aristocratic  circle  of  Athens.  In  that 
most  festive  of  all  festal  occasions,  at  the  house  of  Agathon, 
described  in  the  Symposium,  Eryximachus,  a  physician 

'  Dialogmit  v.  240.        '  Ibid.  ui.  (M.  3  ibid.  i.  404. 

78 


i 

I 


PHYSIC  AND  PHYSICIANS 

and  the  son  of  one,  is  a  chief  speaker,  and  in  his  praise  ol 
love  says,  "  from  medicine  I  will  begin  that  I  may  do 
honour  to  my  art."  We  find  him,  too,  on  the  side  of  tem- 
perance and  sobriety:  "The  weak  heads  like  myself, 
Aristodemus,  Phsedros,  and  others  who  never  can  drink, 
are  fortunate  in  finding  that  the  stronger  ones  are  not  in  a 
drinking  mood.  (I  do  not  include  Socrates,  who  is  able 
either  to  driiUc  or  to  abstain,  and  will  not  mind,  which- 
ever we  do.)  Well,  as  none  of  the  company  seem  disposed 
to  drink  much,  I  may  be  forgiven  for  saying,  as  a  physician, 
that  drinking  deep  is  a  bad  practice,  which  I  never  follow, 
if  I  can  help,  and  certainly  do  not  recommend  to  another, 
least  of  all  to  any  one  who  still  feels  the  effect  of  yester- 
day's carouse."  The  prescriptions  for  hiccough,  given  by 
Eryximachua,  give  verisimilitude  to  the  dialogue.  When 
the  turn  of  Aristophanes  came  he  had  eaten  too  much  and 
had  the  hiccough,  and  he  said  to  Eryximachus,  "  You 
ought  either  to  stop  my  hiccough  or  speak  in  my  turn." 
Eryximachus  recommended  him  to  hold  bis  breath,  or  if 
that  failed  to  gargle  with  a  little  water,  and  if  the  hic- 
cough still  continued,  to  tickle  his  nose  with  something 
and  sneeze,  adding,  "  if  you  sneeze  once  or  twice  even  the 
most  violent  hiccough  is  sure  to  go." ' 

Upon  the  medical  s3nnptonxs  narrated  in  that  memo- 
rable scene,  unparalleled  in  literature,  after  Socrates  had 
drank  the  poison  in  prison,  it  is  unnecessary  to  dwell ; 
but  I  may  refer  to  on<>  aspect  as  indicating  the  reverence 
felt  for  the  representative  of  the  great  Healer.  Denied 
hia  wish  (by  the  warning  of  the  jailor,  who  says  that  there  is 
only  sufficient  poison)  to  offer  a  libation  to  a  god,  Socrates' 
*  DicUoguts,  i.  546.  &o6,  S56. 
74 


AS  DEPICTED  IN  PLATO 

dying  words  were,  "  Crito,  we  owe  a  cock  to  Aaoulapius." 
"  The  meaning  of  this  solemnly  smiling  farewell  of  Socrates 
would  seem  to  be,"  according  to  Dyer,  "  that  to  .^scula- 
pitts,  a  god  who  always  is  prescribing  potions  and  whose 
power  is  manifest  in  their  effects,  was  due  that  most  wel> 
come  and  sovereign  remedy  wliich  cured  all  the  pains  and 
ended  all  the  woes  of  Socrates — ^the  hemlock,  which  cured 
him  of  life  which  is  death,  and  gave  him  the  glorious  reali- 
ties of  hereafter.  For  this  great  boon  of  awakening  into 
real  life  Socrates  owed  ^Esculapius  a  thankoffering.  This 
offering  of  a  cock  to  ^culapius  was  plainly  intended  for 
him  as  the  awakener  of  the  dead  to  life  everlasting." 

And  permit  me  to  conclude  this  abready  too  long  account 
with  the  eulogium  of  Professor  Jowett — words  worthy  of 
the  master,  worthy  of  his  great  interpreter  to  this  genera- 
tion: 

"More  than  two  thousand  two  hundred  years  have 
passed  away  since  he  returned  to  the  place  of  Apollo  and 
the  Muses.  Yet  the  echo  of  his  words  continues  to  be 
heard  among  men,  because  of  all  philosophers  he  has  the 
most  melodious  voice.  He  is  the  inspired  prophet  or 
teacher  who  can  never  die,  the  only  one  in  whom  the  out- 
ward form  adequately  represents  the  fair  soul  within ;  in 
whom  the  thoughts  of  all  who  went  before  him  are  reflected 
and  of  all  who  come  after  him  are  partly  anticipated. 
Other  teachers  of  philosophy  are  dried  up  and  withered — 
after  a  few  centuries  they  have  become  dust ;  but  he  ia 
fresh  and  blooming,  and  is  always  begetting  new  ideas  in 
the  minds  of  men.  They  are  one-sided  and  abstract ; 
but  he  has  many  sides  of  wisdom.  Nor  is  he  alwa3rs  con- 
sistent with  himself,  because  he  is  always  moving  onward, 

76 


•»h 


PHYSIC  AND  PHYSICIANS 
and  knows  that  there  are  many  more  things  in  philosophy 
than  can  be  expressed  in  words,  and  that  truth  is  greater 
than  consistency.  He  who  approaches  him  in  the  most 
reverent  spirit  shall  reap  most  of  the  fruits  of  his  wisdom  ; 
he  who  reads  him  by  the  light  of  ancient  commentators 
will  have  the  least  understanding  of  him. 

"  We  may  see  him  with  the  eye  of  the  mind  in  the  groves 
of  the  Academy,  or  on  the  banks  of  the  Ilissus,  or  in  the 
streets  of  Athens,  alone  or  walking  with  Socrates,  full  of 
these  thoughts  which  have  since  become  the  common 
possession  of  mankind.  Or  we  may  compare  him  to  a 
statue  hid  away  in  some  temple  of  Zeus  or  ApoUo,  no 
longer  existing  on  earth,  a  statue  which  has  a  look  as  of 
the  God  himself.  Or  we  may  once  more  imagine  him 
foUowing  in  another  state  of  being  the  great  company  of 
heaven  which  he  beheld  of  old  in  a  vision  {Phcddnu,  248). 
So,  '  partly  trifling  but  with  a  degree  of  seriousness '  '{Sym- 
posium,  197,  E),  we  linger  around  the  memory  of  a  world 
which  has  passed  away  {Phcedrut,  S280,  C)." 


If  ■ 


w 


76 


THE   LEAVEN   OF   SCIENCE 


77 


,BSSL 


IK.Mi 


'^ 


KnowMge  oomes, 


bat  wiidom  lingen. 

Loektley  Hall,  TKTinrsoH. 


Who  bres  not  knowledge  t    Who  shall  rail 
Against  her  beauty  T    May  sho  mix 
With  men  and  proaper !    Who  shall  fix 

Her  piUan  T    Let  hw  work  prevuL 

In  Mtmoriam,  CXIV,  Tmsvyws 


78 


THE  LEAVEN  OF  SCIENCE' 


I 


IN  the  continual  remembrance  of  a  glorious  pait  indi- 
viduals and  nations  find  their  noblest  inspiration,  and 
if  to-uivy  this  inspiration,  so  valuable  for  its  own  sake,  so 
important  in  its  associations,  is  weakened,  is  it  not  because 
in  the  strong  dominance  of  the  individual,  so  charaoteristio 
of  a  democracy,  we  have  lost  the  sense  of  continuity  1  As 
we  read  in  Roman  history  of  the  ceremonies  commemorative 
of  the  departed,  and  of  the  scrupulous  care  with  which, 
even  at  such  private  festivals  as  the  Ambarvalia,  the  dead 
were  invoked  and  remembered,  we  appreciate,  though 
feebly,  the  part  which  this  sense  of  continuity  played  in 
the  lives  of  their  successors— an  ennobling,  influence, 
through  which  the  cold  routine  of  the  present  received  a 
glow  of  energy  from  "  the  touch  divine  of  noble  natures 
tone."  In  our  modem  lives  no  equivalent  to  this  feeling 
exists,  and  the  sweet  and  gracious  sense  of  an  ever>present 
immortality,  recognized  so  keenly  and  so  closely  in  the 
religion  of  Numa,  has  lost  all  value  to  us.  We  are  even 
impatient  of  those  who  would  recall  the  past,  and  who 

>  WiatM-  lutitate  of  Anatomy  and  Biology  of  the  UoiTenHy 
of  Fannqrlvaaia,  1894. 

79 


mtM 


Hi 
Hi 
Hi, 

lb 


28 

|3j2 

|40 


1^ 

1 2.2 

12.0 
1.8 


MICROCOPY  RESOLUTION  TEST  CHART 

NATIONAL  BUREAU  OF  STANDARDS 

STANDARD  REFERENCE  MATERIAL  1010a 

(ANSI  and  ISO  TEST  CHART  No.  2) 


11 


THE   LEAVEN   OF  SCIENCE 

would  insist  upon  the  importance  of  its  recognition  as  a 
factor  in  our  lives,  impatient  as  we  are  of  everything  save 
the  present  with  its  prospects,  the  future  with  its  possi- 
bilities. Year  by  year  the  memory  of  the  men  who  made 
this  institution  fades  from  ont  the  circle  of  the  hills,  and 
the  shadow  of  oblivion  falls  deeper  and  deeper  over  their 
forms,  until  a  portrait,  or  perhaps  a  name  alone,  remains 
to  link  the  dead  with  the  quick.  To  be  forgotten  seems 
inevitable,  but  not  without  a  sense  of  melancholy  do  we 
recognize  that  the  daily  life  of  three  thousand  students 
and  teachers  is  passed  heedless  of  the  fame,  careless  of  the 
renown  of  these  men ;  and  in  the  second  state  sublime  it 
must  sadden  the  "  circle  of  the  wise,"  as  they  cast  their 
eyes  below,  to  look  down  on  festivals  in  which  they  play 
no  part,  on  gatherings  in  which  their  names  are  neither 
invoked  nor  blessed.  But  ours  the  loss,  since  to  us,  distant 
in  humanity,  the  need  is  ever  present  to  cherish  the  me- 
mories of  the  men  who  in  days  of  trial  and  hardship  laid 
on  broad  lines  the  foundations  of  the  old  colonial  colleges. 

To-day,  through  the  liberality  of  General  Wistar,  we 
dedicate  a  fitting  monument  to  one  of  the  mighty  dead  of 
the  University— Caspar  Wistar.  The  tribute  of  deeds 
has  already  been  paid  to  him  in  this  splendid  structure, 
to  all  m  the  stately  group  of  academic  buildings  which  you 
now  see  adorning  the  campus— the  tribute  of  words  remains, 
to  be  able  to  offer  which  I  regard  a  very  special  honour. 

But  as  this  is  an  Institute  of  Anatomy,  our  tribute  to- 
day may  be  justly  restricted,  in  its  details  at  least,  to  a 
eulogy  upon  the  men  who  have  taught  the  subject  in  this 
University.  About  the  profes£,or8hip  of  anatomy  cluster 
memories  which  give  it  precedence  of  all  others,  and  in  the 

80 


THE   LEAVEN   OF  SCIENCE 


septemviri  of  the  old  school  the  chairs  were  arranged,  with 
that  of  anatomy  in  the  centre,  with  those  of  physiology, 
chemistry,  and  materia  medica  on  the  left,  and  with  those 
of  practice,  surgery,  and  obstetrics  on  the  right.  With  the 
revival  of  learning  anatomy  brought  life  and  liberty  to  the 
healing  art,  and  throughout  the  sixteenth,  seventeenth, 
and  eighteenth  centuries  the  great '  ames  of  the  profession, 
with  but  one  or  two  exceptions,  are  those  of  the  great  anat- 
omists. The  University  of  Pennsylvania  has  had  an  extra- 
ordinary experience  in  the  occupancy  of  this  important 
chair.  In  the  century  and  a  quarter  which  ended  with  the 
death  of  Leidy,  six  names  appear  on  the  faculty  roll  as 
professors  of  this  branch.  Dorsey,  however,  only  delivered 
the  introductory  lecture  to  the  course,  and  was  seized  the 
same  evening  with  his  fatal  illness ;  and  in  the  next  year 
Physick  was  transferred  from  the  chair  of  surgery,  with 
Homer  as  his  adjunct.  In  reality,  therefore,  only  four 
men  have  taught  anatomy  in  this  school  since  its  foundation. 
Physick's  name  must  ever  be  associated  with  the  chair  of 
surgery.  We  do  not  know  the  faculty  exigencies  which 
led  to  the  transfer,  but  we  can  readily  surmise  that  the 
youthfulness  of  Horner,  who  was  only  twenty-six,  and  the 
opportunity  of  filching  for  surgery  so  strong  a  man  as  Gibson 
from  the  Faculty  of  the  University  of  Maryland,  then  a 
stout  rival,  must  have  been  among  the  most  weighty  con- 
siderations. 

If  in  the  average  length  of  the  period  of  each  incumbency 
the  chair  of  anatomy  in  the  University  is  remarkable,  much 
more  so  is  it  for  the  quality  of  the  men  who  followed  each 
other  at  such  long  intervals.  It  is  easy  to  praise  the 
Athenians  among  the  Athenians,  but  where  is  the  school 

▲E.  81  o 


THE   LEAVEN   OF  SCIENCE 


I:) 


in  this  country  which  can  show  such  a  succession  of  names 
in  this  branch :  Shippen,  the  first  teacher  of  anatomy ; 
Wistar,  the  author  of  the  first  text-book  of  anatomy ; 
Homer,  the  first  contributor  to  human  anatomy  in  this 
country ;  and  Leidy,  one  of  the  greatest  comparative 
anatomists  of  his  generation  ?  Of  European  schools, 
Edinburgh  alone  presents  a  parallel  picture,  as  during  the 
same  period  only  four  men  have  held  the  chair.  The  long- 
evity and  tenacity  of  the  three  Monros  have  become  pro- 
verbial ;  in  succession  they  held  the  chair  of  anatomy  for 
126  years.  Shortly  before  the  foundation  of  this  school 
Monro  secundus  had  succeeded  his  father,  and  taught  un- 
interruptedly for  fifty  years.  His  son,  Monro  tertixis,  held 
the  chair  for  nearly  the  same  length  of  time,  and  the  re- 
mainder of  the  period  has  been  covered  by  the  occupancy 
of  John  Goodsir,  and  his  successor.  Sir  William  Turner, 
the  present  incumbent. 

To  one  feature  in  the  history  of  anatomy  in  this  school 
I  must  refer  in  passing.  Shippen  was  a  warm  personal 
friend  and  house-pupil  of  John  Hunter.  Physick  not  only 
had  the  same  advantages,  but  became  in  addition  his  house- 
surgeon  at  St.  George's  Hospital.  Both  had  enjoyed  the 
intimate  companionship  of  the  most  remarkable  observer 
of  nature  since  ArLstotle,  of  a  man  with  wider  and  more 
scientific  conceptions  and  sympathies  than  had  ever  before 
been  united  in  a  member  of  our  profession,  and  whose  funda- 
mental notions  of  disease  are  only  now  becoming  prevalent. 
Can  we  doubt  that  from  this  source  was  derived  the  power- 
ful inspiration  which  sustained  these  young  men.  One 
of  them,  on  his  return  from  England,  at  once  began  the 
first  anatomical  classes  which  were  held  in  the  colonies ; 

82 


THE   LEAVEN   OF  SCIENCE 

the  other  entered  upon  that  career  so  notable  and  so  honour- 
able, which  led  to  the  just  title  of  the  Father  of  American 
Surgery.  It  is  pleasant  to  think  that  direct  from  John 
Hunter  came  the  influence  which  made  anatomy  so  strong 
in  this  school,  and  that  zeal  in  the  acquisition  of  specimens 
which  ultimately  led  to  the  splendid  conections  of  the 
Wistar-Homer  Museum. 

William  Shippen  the  younger  shares  with  John  Morgan 
the  honour  of  establishing  medical  instruction  in  this  city. 
When  students  in  England  they  had  discussed  plans,  but  it 
was  Morgan  who  seems  to  have  had  the  ear  of  the  trustees, 
and  who  broached  a  definite  scheme  in    his   celebrated 
"Discourse,"  delivered  in  May,  1765.    It  was  not  until 
the  autumn  of  the  year  that  Shippen  signified  to  the  board 
his  willingness  to  accept  a  professorship  of  anatomy  and 
surgery.    He  had  enjoyed,  as  I  have  mentioned,  the  friend- 
ship of  John  Hunter,  and  had  studied  also  with  his  cele- 
brated brother,  William.    Associated  v/ith  him  as  fellow - 
pupil  was  William  Hewson,  who  subsequently  became  so 
famous  as  an  anatomist  and  physiologist,  and  as  the  dis- 
coverer of  the  leucocytes  of  the  blood,  and  whose  descend- 
dants  have  been  so  prominent  in  the  profession  of  this  city. 
No  wonder,  then,  with  such  an  education,  that  Shippen, 
on  his  return  in  1762,  in  his  twenty-sixth  year,  should  have 
begun  a  course  of  lectures  in  anatomy,  the  introductory 
to  which  was  delivered  in  the  State  House  on  November  16. 
To  him  belongs  the  great  merit  of  having  made  a  beginning, 
and  of  having  brought  from  the  Hunters  methods  and 
traditions  which  long  held  sway  in  this  school.     VVistar 
in  his  eulogium  pays  a  warm  tribute  to  his  skill  as  a  lecturer 
and  as  a  demonstrator,  and  to  the  faithfulness  with  which 

88 


If 


Mi! 

fi. 


i 


u 


THE  LEAVEN  OF  SCIENCE 

he  taught  the  subject  for  more  than  forty  years.  Apart 
from  his  comiection  with  this  institution  he  served  as 
Director-General  of  the  Military  Hospitals  from  1777  to 
1781,  and  was  the  second  president  of  the  College  of  Phy- 
sicians. 

In  the  history  of  the  profession  o''  this  country  Caspar 
Wistar  holds  an  unique  position.  He  is  its  Avicenna,  its 
Mead,  its  Fothergill,  the  very  embodiment  of  the  physician 
who,  to  paraphrape  the  words  of  Armstrong,  used  by  Wistar 
in  his  Edinburgh  Graduation  Thesis,  "  Sought  the  cheerful 
haunts  of  men,  and  minglei  with  the  bustling  crowd." 
He  taught  anatomy  in  this  school  as  adjunct  and  professor 
for  twenty-six  years.  From  the  records  of  his  contem- 
poraries we  learn  that  he  was  a  brilliant  teacher,  "  the 
idol  of  his  class,"  as  one  of  his  eulogists  says.  As  an  anat- 
omist he  will  be  remembered  as  the  author  of  the  first 
American  Text-Book  on  Anatomy,  a  work  which  was 
exceedingly  pop\ilar,  and  ran  through  several  editions. 
His  interest  in  the  subject  was  not,  however,  of  the  "  knife 
and  fork  "  kind,  for  he  was  an  early  student  of  mammalian 
palaeontology,  in  the  development  of  which  one  of  his 
successors  was  to  be  a  chief  promotor.  But  Wistar's 
claim  to  remembrance  rests  less  upon  his  writings  than 
upon  the  impress  which  remains  to  this  day  of  his  methods 
of  teaching  anatomy.  Speaking  of  these,  Horner,  who 
was  his  adjunct  and  intimate  associate,  in  a  letter  dated 
February  1,  1818,  says,  "  In  reviewing  the  several  parti- 
culars of  his  course  of  instruction,  it  is  difl&cult  to  say  in 
what  part  his  chief  merit  consisted ;  he  undertook  every- 
thing with  so  much  zeal,  and  such  a  conscientious  desire 
to  benefit  those  who  came  to  be  instructed  by  him,  that 

84 


A 


THE  LEAVEN  OF  SHENCE 

he  seldom  failed  of  giving  the  most  complete  satisfaction. 
There  ware,  however,  some  parts  of  his  course  peciiliar  to 
himself.  These  were  the  addition  of  models  on  a  very 
large  scale  to  illustrate  small  parts  of  the  human  structure  ; 
and  the  division  of  the  general  class  into  a  number  of  sub- 
classes, each  of  which  he  supplied  with  a  box  of  bones,  in 
order  that  they  might  become  thoroughly  acquainted 
with  the  human  skeleton,  a  subject  which  is  acknow- 
ledged by  all  to  be  at  the  very  foundation  of  anatomical 
knowledge.  The  idea  of  the  former  mode  of  instruction 
was  acted  on  for  the  first  time  about  fifteen  years  ago." 
We  have  no  knowledge  of  a  collection  of  speciniens  by 
Shippen,  thougn  it  is  hard  to  believe  that  he  could  have 
dwelt  in  John  Hunter's  house  and  remained  free  from  the 
insatiable  hunger  for  specimens  which  characterized  his 
master.  But  the  establishment  of  a  museum  as  an  impor- 
tant adjunct  to  the  medical  school  was  due  to  Wistar, 
whose  collections  formed  the  nucleus  of  the  splended  array 
wbich  you  will  inspect  to-day.  The  trustees,  in  acceT>*,ing 
the  jnft  on  the  death  of  Dr.  Wistar,  agreed  that  it  should 
be  styled  the  Wistar  Museum,  and  now,  after  the  lapse 
of  seventy-six  years,  the  collection  has  found  an  appro- 
priate home  in  an  Institute  of  Anatomy  which  bears  his 
honoured  name. 

But  Wistar  has  established  a  wider  claim  to  remem- 
brance. Genial  and  hospitable,  he  reigned  supreme  in 
society  by  virtue  of  exceptional  qualities  of  heart  and 
head,  and  became,  in  the  language  of  Charles  Caldwell, 
"  the  i,en8ori'''n  commune  of  i  large  circle  of  friends." 
About  no  other  name  in  our  ranks  cluster  such  memories 
of  good  fellowship  and  good  cheer,  and  it  stands  to-day  in 

85 


1 


'I 

1 

I 

( 


THE   LEAVEN  OF  SCIENCE 

this  city  a  synonyva  for  esprit  and  social  intercourse. 
Year  by  year  his  face,  printed  on  the  invitations  to  the 
"  Wistar  Parties  "  (still  an  important  function  of  winter 
life  in  Philadelphia)  perpetuates  the  message  of  his  life, 
"  Go  seek  the  cheerful  haunts  of  men." 

How  different  was  the  young  prosector  and  adjunct  who 
next  taught  the  subject !  Horner  was  naturally  reserved 
and  diffident,  and  throughout  his  life  those  obstinate  ques- 
tionings which  in  doubt  and  suffering  have  so  often  wrung 
the  heart  of  man  were  ever  pre&ent.  Fightings  within  and 
fears  without  harassed  his  gentle  and  sensitive  soul,  on 
which  mortality  weighed  heavily,  and  to  which  the  four 
last  things  were  more  real  than  the  materials  in  which  he 
worked.  He  has  left  us  a  journal  intime,  in  which  he  found, 
as  did  Amiel,  of  whom  he  was  a  sort  of  medical  prototype, 
"  a  safe  shelter  wherein  his  questionings  of  fate  and  the 
future,  the  voice  of  grief,  of  self-examination  and  confession, 
the  soul's  cry  for  inward  peace,  might  make  themselves 
freely  heard."  Listen  to  him  :  "  I  have  risen  early  in 
the  morning,  ere  yet  the  watchman  had  cried  the  last  hour 
of  his  vigil,  and  in  undisturbed  solitude  giving  my  whole 
heart  and  understanding  to  my  Maker,  prayed  fervently 
that  I  might  be  enlightened  on  this  momentous  subject, 
that  I  might  be  freed  from  the  errors  of  an  excited  imacina- 
tion,  from  the  allurements  of  personal  friendship,  from 
the  prejudices  of  education,  and  that  I  might,  under  the 
influence  of  Divine  grace,  be  permitted  to  settle  this  ques- 
tion in  its  true  merits."  How  familiar  is  the  cry,  the  great 
and  exceeding  bitter  cry  of  the  strong  soul  in  the  toils  and 
doubtful  of  the  victory  !  Horner,  however,  was  ont  of 
those  on  whom  both  blessings  rested.    Facing  the  spectres 

86 


% 

% 


THE   LEAVEN   OF  SCIENCE 

of  the  mind,  he  laid  them,  and  reached  the  desired  haven. 
Ill  spite  of  feeble  bodily  health  and  fits  of  depression,  he 
carried  on  his  anatomical  studies  with  zeal,  and  as  an  ori- 
ginal worker  and  author  brought  much  reputation  to  the 
University.  Particularly  he  enriched  the  museum  with 
many  valuable  preparations,  and  his  name  will  ever  be 
associated  with  that  of  Wistar  in  the  anatomical  collection 
which  bears  their  names. 

But  whut  shall  I  say  of  Leidy,  the  man  in  whom  the 
leaven  of  'jcience  wrought  with  labour  and  travail  for  so 
many  The    written    record    survives,    scarcely 

equah  '-ety  and  extent  by  any  naturalist,  but  how 

meagre.  .  pict"  e  of  the  man  as  known  to  his  friends. 

The  traits  which  luade  his  life  of  such  value— the  patient 
spirit,  the  kindly  disposition,  the  sustained  zeal— we  shall 
not  see  again  incarnate.    The  memory  of  them  alone  re- 
mains.   As  the  echoes  of  the  eulogies  upon  his  life  have 
scarcely  died  away,  I  need  not  recount  to  this  audience  his 
ways  and  work,  but  upon  one  aspect  of  his  character  I  may 
dwell  for  a  moment,  as  illustrating  an  influence  of  science 
which  has  attracted  much  attention  and  aroused  discussion. 
So  far  as  the  facts  of  sense  were  concerned,  there  was  not 
a  trace  of  Pyrrhonism  in  his  composition,  but  in  all  that 
relates  to  the  ultra-rational  no  more  consistent  disciple  of 
the  great  sceptic  ever  lived.    There  was  in  him,  too,  that 
delightful  "  ataraxia,"  that  imperturbability  which  is  the 
distinguishing  feature  of  the  Pyrrhonist,  in  the  truest  sense 
of  the  word.    A  striking  parallel  exists  between  Leidy 
and  Darwin  in  this  respect,  and  it  is  an  interesting  fact 
that  the  two  men  ot  this  century  who  have  lived  in  closest 
intercourse  >vith  nature  should  have  found  full  satisfaction 

87 


I*'' 


THE  LEAVEN  OF  SCIENCE 

in  their  studies  and  in  their  domestic  affections.    In  the 
autobiographical  section  of  the  life  of  Charles  Darwin, 
edited  by  his  son  Francis,  in  •  Mch  are  laid  bare  with  such 
charming  frankness  the  inner  thoughts  of  the  great  natura- 
list, we  find  that  he,  too,  had  reached  in  suprasensuous 
affairs  that  state  of  mental  imperturbability  in  which,  to 
borrow  the  quaint  expression  of  Sir  Thomas  Browne,  they 
stretched  not  his  pia  mater.    But  while  acknowledging 
that  in  science  scepticism  is  advisable,  Darwin  says  that 
he  was  not  himself  very  sceptical.    Of  these  two  men,  aUke 
in  this  pomt,  and  with  minds  distinctly  of  the  Aristotelian 
type,  Darwin  yet  retained  amid  an  overwhelming  accumula- 
tion of  facts— and  here  was  his  great  superiority— an  extra- 
ordinary power  of  generalizing  principles  from  them.    Defi- 
cient as  was  this  quality  in  Leidy,  he  did  not,  on  the  other 
hand,  experience  "  the  curious  and  lamentable  loss  of  the 
higher  aesthetic  taste  "  which  Darwin  mourned,  and  which 
may  have  been  due  in  part  to  protracted  ill  health,  and  to 
an  absolute  necessity  of  devoting  all  his  powers  to  collecting 
facts  in  support  of  his  great  theory. 

When  I  think  of  Leidy's  simple  life,  of  his  devotion  to 
the  study  of  nature,  of  the  closeness  of  his  communion  with 
her  for  so  many  years,  there  recur  to  my  mind  time  and 
again  the  lines, — 


imi 


He  is  made  one  with  nature :  there  is  heard 
His  voice  in  all  her  music,  from  the  moan 

Of  thunder,  to  the  song  of  night's  sweet  bird ; 
He  is  a  presence  to  be  felt  and  known 

In  darkness  and  in  light,  from  herb  and  stone. 
Spreading  itself  where'er  that  Power  may  move 

Which  has  withdrawn  bia  being  to  its  own, 

88 


i!i 


1 

I 


-M 


THE  LEAVEN   OF  SCIENCE 

II 
Turning  from  the  men  to  the  subject  in  which  they  worked, 
from  the  past  to  the  present,  let  us  take  a  hasty  glance  at 
some  of  the  developments  of  human  anatomy  and  biology. 
Truth  has  been  well  called  the  daughter  of  Time,  and  even 
in  anatomy,  which  is  a  science  in  a  state  of  fact,  the  point 
of  view  changes  with  successive  generations.  The  following 
story,  told  by  Sir  Robert  Christison,  of  Barclay,  one  of  the 
leading  anatomists  of  the  early  part  of  this  century,  illus- 
trates the  old  a.  Ae  of  mind  still  met  with  among  "  bread 
and  butter  "  teaches  of  the  subject.  Barclay  spoke  to 
his  class  as  follows :  "  Gentlemen,  while  canying  on  your 
work  in  the  dissecting-room,  beware  of  making  anatomical 
discoveries ;  and  above  all  beware  of  rushing  with  them 
into  print.  Our  precursors  have  left  us  little  to  discover. 
You  may,  perhaps,  fall  in  with  a  supernumerary  muscle  or 
tendon,  a  slight  deviation  oi  extra  branchlet  of  an  artery, 
or,  perhaps,  a  minute  stra<'  twig  of  a  nerve — that  will  be 
all.  But  beware  !  Publish  :hc  fact,  and  ten  chances  to 
one  you  will  have  it  shown  that  yo'  have  been  forestalled 
long  ago.  Anatomy  may  be  likened  to  a  harvest-field. 
First  come  the  reapers,  who,  entering  upon  untrodden 
ground,  cut  down  great  store  of  com  from  all  sides  of  them. 
These  are  the  early  anatomists  of  modem  Europe,  such  as 
Vesalius,  Fallopius,  Malpighi,  and  Harvey.  Then  come 
the  gleaners,  who  gather  up  ears  enough  from  the  bare 
ridges  to  make  a  few  loaves  of  bread.  Such  were  the 
anatomists  of  last  century — Valsalva,  Cotunnius,  Haller, 
Winslow,  Vicq  d'Azyr,  Camper,  Hunter,  and  the  two 
Monros.  Last  of  all  come  the  geese,  who  still  contrive  to 
pick  up  a  few  grains  scattered  here  and  there  among  the 

89 


II 


H 


'hi 


M  1 


THE   LEAVEN  OF   SCIENCE 

stubble,  and  waddle  borne  in  the  evening,  poor  things, 
cackling  with  joy  because  of  thoir  succecss.  Gentlemen, 
we  are  tht  ^^cse."  Yes,  geese  they  were,  gleaning  amid 
the  stubble  of  a  restricted  field,  when  the  broad  acres  of 
biology  were  open  before  them.  Those  were  the  days 
when  anatomy  meant  a  knowledge  of  the  human  frame 
alone  ;  and  yet  the  way  had  been  opened  to  the  larger  view 
by  the  work  of  John  Hunter,  whose  comprehensive  mind 
grasped  as  proper  subjects  of  study  for  the  anatomist  all 
the  manifestations  of  life  in  order  and  disor_er. 

The  determination  of  structure  with  a  view  to  the  dis- 
covery of  function  has  been  the  foundation  of  progress. 
The  meaning  may  not  always  have  been  for  "  him  who 
runs  to  read ; "  often,  indeed,  it  has  been  at  the  time  far 
from  clear ;  and  yet  a  knowledge  in  full  detail  of  the  form 
and  relations  must  precede    ;  correct  physiology.    The 
extraordinary  development  oi  ^u  the  physical  sciences, 
and  the  corresponding  refinement  of  means  of  research, 
have  contributed  most  largely  to  the  enlightenment  of  the 
"  geese  "  of  Barclay's  witticism.    Take  the  progress  in  any 
one  department  which  has  a  practical  aspect,  such  as,  in 
the  anatomy  and  physiology  of  the  nervous  system.    Read, 
for  example,  in  the  third  edition  of  Wistar's  Anatomy. 
edited  by  Horner  in  1825,  the  description  of  the  convolu- 
tions of  the  brain,  on  which  to-day  a  whole  army  of  special 
students  are  at  work,  medical,  surgical,  and  anthropological, 
and  the  functions  of  which  are  the  objective  poirt  of  physio- 
logical and  psychological  research— the  whole  subject  is 
thus  disposed  of :  "  The  surface  of  the  brain  resembles  that 
of  the  mass  of  the  small  intestine,  or  of  a  convoluted,  cylin- 
drical tube ;  it  is,  '     .efore,  said  to  be  convoluted.    Tlie 

90 


1 


THE   LEAVEN   OF  SCIENCE 

fissures  between  these  convolu^'ons  do  not  extend  very 
deep  into  the  substance  of  the  t.;  ain."    The  knowledge  of 
fimction  rnrrelated  with  this  meagre  picture  of  structure 
is  best  expressed,  perhaps,  in  Shakesp'^arian  diction,  "  that 
when  the  brains  were  out,  the  man  would  die."      The 
laborious,  careful  establishment  of  structure  by  the  first 
two  generations  in  this  century  led  to  those  brilliant  dis- 
coveries in  the  functions  of  the  nervous  system  which  have 
not  only  revolutionized  medicine,  but  have  almost  enabled 
psychologists  to   dispense   with  metaphysics  ^'together. 
It  is  pa-ticularly  int<'resting  to  note  the  widespread  depend- 
ence of  many  departments  on  accurate  anatomijal  know- 
ledge.   The  new  cerebral  anatomy,  partir'-  'arly  the    Uidy 
of  the  surface  of  the  brain,  so  summaril      .Ismissed  »n  a 
few  lines  by  Wistar,  made  plain  the  path  for  Hitzig  and 
Fritsch,  the  careful  dis.section  of  cases  of  disease  of  the 
brain  prepared  the  way  for  Hughlings  Jackson  ;  and  gra- 
dually a  new  phrenology  on  a  scientific  basis  has  replaced 
the  crude  notions  of  Gall  and  Spurzheim  ;  so  that  with  the 
present  generation,  little  by  little,  there  has  been  established 
on  a  solid  structure  of  anatomy,  the  localization  of  many 
of  the  functions  of  the  brain.    Excite  with  a  rougV  touch, 
from  within  or  from  without,  a  small  region  of  that  mysteri- 
ous surface,  and  my  lips  may  move,  but  not  in  the  articu- 
lote  expression  of  thought,  and  I  may  see,  but  I  cannot 
read  the  page  before  me  ;  touch  here  and  sight  is  gone, 
and  there  again  and  hearing  fails.    One  by  one  the  centres 
may  be  touched  which  preside  over  the  muscles,  and  they 
may,  singly  or  together,  lose  their  power.    All  these  func- 
tions may  go  without  the  loss  of  consciousness.    Touch 
with  the  slow  finger  of  Time  the   nutrition  of  that  thiu 

91 


:'.* 


i     ! 


THE  LEAVEN  OF  SCIENCE 

layer,  and  backward  by  slow  degrees  creep  the  intellectual 
faculties,  back  to  childish  simplicity,  back  to  infantile 
silliness,  back  to  the  oblivion  of  the  womb. 

To  this  new  cerebral  physiology,  which  has  thus  grad- 
ually developed  with  increasing  knowledge  of  structure, 
the  study  of  cases  of  disease  has  contributed  enormously, 
and  to-day  the  diagnosis  of  affections  of  the  nervous  system 
has  reached  an  astonishing  degree  of  accuracy.    The  inter- 
dependence and  sequence  of  knowledge  in  various  branches 
of  science  is  nowhere  better  shown  than  in  this  very  subject. 
The  facts  obtained  by  precise  anatomical  investigation, 
from  experiments  on  animals  in  the  laboratory,  from  the 
study  of  nature's  experiments  upon  us  m  disease,  slowly 
and  painfully  acquired  by  many  minds  in  many  lands, 
have  brought  order  out  of  the  chaos  of  fifty  years  ago.    In  a 
practical  age  this  vast  change  has  wrought  a  corresponding 
alteration  in  our  ideas  of  what  may  or  may  not  be  done  in 
the  condition  of  perverted  health  which  we  call  disease,  and 
we  not  only  know  better  what  to  do,  but  also  what  to  leave 
undone.    The  localization  of  centres  in  the  surface  of  the 
brain  has  rendered  it  possible  to  make,  with  a  considerable 
degree  of  certainty,  the  diagnosis  of  focal  disease,  and 
Macewen  and  Horsley  have  supplemented  the  new  cerebral 
physiology  and  pathology  by  a  new  cerebro-spinal  surgery, 
the  achievements  of  which  are  scarcely  credible. 

But  this  is  not  all ;  in  addition  to  the  determination  of 
the  centres  of  sight,  hearing,  speech,  and  motor  activities, 
we  are  gradually  reaching  a  knowledge  of  the  physical 
basis  of  mental  phenomena.  The  correlation  of  intelli- 
gence and  brain  weight,  of  mental  endowment  and  in- 
creased convolution  of  the  brain  surface,  was  recognized 

92 


L^ 


THE   LEAVEN  OF  SCIENCE 

even  by  the  gleaners  of  Barclay's  story ;  but  within  the 
past  twenty-five  years  the  minute  anatomy  of  the  organ 
has  been  subjected  to  extensive  study  by  methods  of  ever- 
increasing  delicacy,  which  have  laid  bare    its    complex 
mechanism.    The  pyramidal  cells  of  the  cerebral  grey 
matter  constitute  the  anatomical  basis  of  thought,  and 
with  the  development,  association,  and  complex  connection 
of  these  psychical  cells,  as  they  have  been  termed,  the 
psychical  functions  are  correlated.    How  far  these  mechan- 
ical conceptions  have  been  carried,  may  be  gathered  from 
the  recent  Croonian  Lecture  before  the  Royal  Society,  in 
which  Ram6n  y  Cajal  based  the  action  and  the  degree,  and 
the  development  of  intelligence  upon  the  complexity  of 
the  cell  mechanism  and  its  associations.    Even  the  physical 
basis  of  moody  madness  has  not  evaded  demonstration. 
Researches  upon  the  finer  structure  of  the  cerebral  cortex 
lead  to  the  conclusion  that  imbecility,  mental  derange- 
ment, and  the  various  forms  of  insanity  are  but  symptoms 
of  diseased  conditions  of  the  pyramidal  cells,  and  not  separ- 
ate affections  of  an  indefinable  entity,  the  mind.    Still 
further ;  there  is  a  school  of  anthropologists  which  strives 
to  associate  moral  derangement  with  physical  abnormali- 
ties, particularly  of  the  brain,  and  urges  a  belief  in  a  cri- 
minal psychosis,  in  which  men  are  "  villains  by  necessity, 
fools  by  heavenly  compulsion,  knaves,  thieves,  and  treachers 
by  spherical  predominance."    This  remarkable  revolution 
in  our  knowledge  of  brain  functions  has  resulted  directly 
from  the  careful  and  accurate  study  by  Barclay's  "  geese," 
of  the  anatomy  of  the  nervous  system.    Truly  the  gleaming 
of  the  grapes  of  Ephraim  has  been  better  than  the  vintage 

of  Abi-ezer. 

93 


1 1 


\  ' 


THE  LEAVEN  OF  SCIENCE 

The  study  of  structure,  however,  as  the  basis  of  vital 
phenomena,  the  strict  province  of  anatomy,  forms  but  a 
small  part  of  the  wide  subject  of  biology,  which  deals  with 
the  multiform  manifestations  of  life,  and  seeks  to  know 
the  laws  governing  the  growth,  development,  and  actions 
of  living  things.    John  Hunter,  the  master  of  Shippen 
and  Physick,  was  the  first  great  biologist  of  the  moderns, 
not  alone  because  of  his  extraordinary  powers  of  observa- 
tion and  the  comprehensive  sweep  of  his  intellect,  but 
chiefly  because  he  first  looked  at  life  as  a  whole,  and  studied 
all  of  its  manifestations,  in  order  and  disorder,  in  health 
and  in  disease.    He  first,  in  the  words  of  Buckle,  "  deter- 
mined to  contemplate  nature  as  a  vast  and  united  whole, 
exhibiting,  indeed,  at  different  times,  different  appearances, 
but  preserving  amidst  every  change,  a  principle  of  uniform 
and  uninterrupted  order,  admitting  of  no  division,  under- 
going no  disturbance,  and  presenting  no  real  irregularity, 
albeit  to  the  common  eye  irregularities  abound  on  every 
side."    We  of  the  medical  profession  may  take  no  little 
pride  in  the  thought  that  there  have  never  been  wanting 
men  in  our  ranks  who  have  trodden  in  the  footsteps  of  this 
great  man ;  not  only  such  giants  as  Owen,  Huxley,  and 
Leidy,  but  in  a  more  humble  way  many  of  the  most  diligent 
students  of  biology  have  been  physicians.    From  John 
Hunter  to  Charles  Darwin  enormous  progress  was  made  in 
every  department  of  zoology  and  botany,  and  not  only  in 
the  accumulation  of  facts  relating  to  structure,  but  in  the 
knowledge  of  function,  so  that  the  conception  of  the  phe- 
nomena of  living  matter  was  progressively  widened.    Then 
with  the  Origin  of  Species  came  the  awakening,  and  the 
theory  of  evolution  has  not  only  changed  the  entire  aspect 

94 


THE  LEAVEN  OF  SCIENCE 


it 


of  biology,  but  has  revolutionized  every  department  of 
human  thought. 

Even  the  theory  itself  has  come  within  the  law  ;  and  to 
those  of  us  whose  biology  is  ten  years  old,  the  new  concep- 
tions are,  perhaps,  a  little  bewildering.  The  recent  litera- 
ture shows,  however,  a  remarkable  fertility  and  strength. 
Around  the  nature  of  cell-organization  the  battle  wages 
most  fiercely,  and  here  again  the  knowledge  of  structure  is 
sought  eagerly  as  the  basis  of  explanation  of  the  vital 
phenomena.  So  radical  have  been  the  changes  in  this 
direction  that  a  new  and  complicated  terminology  has 
sprung  up,  and  the  simple,  undifferentiated  bit  of  proto- 
plasm has  now  its  cytosome,  cytolymph,  caryosome,  chro- 
mosome, with  their  somacules  and  biophores.  These 
accurate  studies  in  the  vital  units  have  led  to  material 
modifications  in  the  theory  of  descent.  Weismann's  views, 
particularly  on  the  immortality  of  the  unicellular  organisms, 
and  of  the  reproductive  cells  of  the  higher  forms,  and  on 
the  transmission  or  non-transmission  of  acquired  characters, 
have  been  based  directly  upon  studies  of  cell-structure  and 
cell-fission. 

In  no  way  has  biological  science  so  widened  the  thoughts 
of  men  as  in  its  application  to  social  problems.  That 
throughout  the  ages,  in  the  gradual  evolution  of  life,  one 
unceasing  purpose  runs ;  that  progress  comes  through 
unceasing  competition,  through  unceasing  selection  and 
rejection ;  in  a  word,  that  evolution  is  the  one  great  law 
controlling  all  living  things,  "  the  one  divine  event  to  which 
the  whole  creation  moves,"  this  conception  has  been  the 
great  gift  of  biology  to  the  nineteenth  century.  In  his 
work  on  Social  Evolution,  Kidd  thus  states  the  problem  in 

95 


, 


,  '/ 


^; 


u 


THE  LEAVEN  OF  SaENCE 

clear  tenns :  "  Nothing  tends  to  exhibit  more  strikingly 
the  extent  to  which  the  study  of  our  social  phenomena 
must  in  future  be  based  on  the  biological  sciences,  than  the 
fact  that  the  technical  controversy  now  being  waged  by 
biologists  as  to  the  transmission  or  non-transmission  to 
offspring  of  qualities  acquired  during  the  lifetime  of  the 
parent,  is  one  which,  if  decided  in  the  latter  sense,  must 
produce  the  most  revolutionary  effect  throughout  the 
whole  domain  of  social  and  political  philosophy.  If  the  old 
view  is  correct,  and  the  effects  of  use  and  education  are 
transmitted  by  inheritance,  then  the  Utopian  dreams  of 
philosophy  in  the  past  are  undoubtedly  possible  of  realiza- 
tion. If  we  tend  to  inherit  in  our  own  persons  the  result 
of  the  education  and  mental  and  moral  culture  of  past 
generations,  then  we  may  venture  to  anticipate  a  future 
society  which  will  not  deteriorate,  but  which  may  continue 
to  make  progress,  even  though  the  struggle  for  existence 
be  suspended,  the  population  regulated  exactly  to  the 
means  of  subsistence,  and  the  antagonism  between  the 
individual  and  the  social  organism  extinguished.  But  if 
the  views  of  the  Weismami  party  are  in  the  main  correct ; 
if  there  can  be  no  progress  except  by  the  accumulation  of 
congenital  variations  above  the  average  to  the  exclusion 
of  others  below  ;  if,  without  the  constant  stress  of  selection 
which  this  involves,  the  tendency  of  every  higher  form  of 
life  is  actually  retrograde;  then  is  the  whole  human  race 
caught  in  the  toils  of  that  struggle  and  rivahy  of  life  which 
has  been  in  progress  from  the  beginning.  Then  must  the 
rivalry  of  existence  continue,  humanized  as  ^o  conditions 
it  may  be,  but  immutable  and  inevitable  to  tne  end.  Then 
also  must  all  the  phenomena  of  human  life^  individual, 

90 


THE  LEAVEN  OF  SHENCE 

political,  social,  and  religious,  be  couidered  as  aspects  of 
this  cosmic  process,  capable  o'  '  ^ing  studied  and  '  der- 
stood  by  science  only  in  theii  relations  thereto."  * 

Biology  touches  the  problems  of  life  at  every  point,  and 
may  claim,  as  no  other  science,  completeness  of  view  and  a 
comprehensiveness  which  pertains  to  it  alone.  To  all 
whose  daily  work  lies  in  her  manifestations  the  value  of 
a  deep  insight  into  her  relations  cannot  be  overestimated. 
The  study  of  biology  trains  the  mind  in  accurate  methods 
of  observation  and  correct  methods  of  reasoning,  and  gives 
to  a  man  clearer  points  of  view,  and  an  attitude  of  mind 
more  serviceable  in  the  working-day-world  than  that  given 
by  other  sciences,  or  even  by  the  humanit'es.  Year  by 
year  it  is  to  be  hoped  that  young  men  will  obtain  in  this 
Institute  a  fundamental  knowledge  of  the  laws  of  life. 

To  the  physician  particularly  a  scioatific  discipline  is  an 
incalculable  gift,  which  leavens  his  whole  life,  giving  exact- 
ness to  habits  of  thought  and  tempering  the  mind  with  that 
judicious  faculty  o'  distrust  which  can  alone,  amid  the 
uncertainties  of  piactice,  make  him  wise  unto  salvation. 
For  perdition  inevitably  awaits  the  mind  of  the  practi- 
tioner who  has  never  had  the  full  inoculation  with  the 
leaven,  wh'^  has  never  grasped  clearly  the  relations  of 
science  to  his  art,  and  who  knows  nothing,  and  perhaps 
cares  less,  for  the  limitations  of  either. 

And  I  may  be  permitted  on  higher  grounds  to  congratu- 
late the  University  of  Pennsylvania  on  the  acquisition  of 
this  Institute.  There  is  greac  need  in  the  colleges  of  this 
councry  of  men  who  are  thinkers  as  well  as  workers — men 
with  ideas,  men  who  have  drunk  deep  of  the  Astral  wine, 

1  Social  Evolution.     .>y  Benjamin  Kidd.  London.  1894. 
AE.  C7  H 


'nmm 


THE  LEAVEN   OP  SCIENCE 


li:! 


m 


and  whose  energies  are  not  sapped  in  the  tread-mill  of  the 
class-room.  In  these  laboratories  will  be  given  opportuni- 
ties for  this  higher  sort  of  university  work.  The  conditions 
about  us  are  changing  rapidly :  in  the  older  states  utility 
is  no  longer  regarded  as  the  test  of  fitness,  and  the  value  of 
the  intellectual  life  has  risen  enormously  in  every  depart- 
ment. Germany  must  be  our  model  in  this  respect.  She 
is  great  because  she  has  a  large  group  of  men  pursuing 
pure  science  with  unflagging  industry,  with  self-denying 
zeal,  and  with  high  ideals.  No  secondary  motives  sway 
their  minds,  no  cry  reaches  them  in  the  recesses  of  their 
laboratories,  "  of  what  practical  utility  is  your  work  ?  " 
but,  unhampered  by  social  or  theological  prejudices,  they 
have  been  enabled  to  cherish  "  the  truth  which  haf  never 
been  deceived — that  'complete  trith  which  carries  with  it 
the  antidote  against  the  bane  and  danger  which  follow  in 
the  train  of  half -knowledge."    (Heknholtz.) 

The  leaven  of  science  gives  to  men  habits  of  mental 
accuracy,  modes  of  thought  which  enlarge  the  mental 
vision,  and  strengthens — to  use  an  expression  of  Epichar- 
mus — "  the  sinews  of  the  understandmg."  But  is  there 
nothing  further  ?  Has  science,  the  last  gift  of  the  gods, 
no  message  of  hope  for  the  race  as  a  whole ;  can  it  do  no 
more  than  impart  to  the  individual  imperturbability  amid 
the  storms  of  life,  judgment  in  times  of  perplexity  ?  Where 
are  the  bright  promises  of  the  days  when  "the  kindly 
earth  should  slumber  rapt  in  universal  law  "  ?  Are  these, 
then,  futile  hopes,  vain  imaginings  of  the  dreamers,  who 
from  Plato  to  Comte  have  sought  for  law,  for  order,  for  the 
civiias  Dei  in  the  regnum  hominis  ? 

Science  has  done  much,  and  will  do  more,  to  alleviate 

98 


THE  LEAVEN   OF  SCIENCE 

the  unhappy  condition  in    /hich  so  many  millions  of  our 
fellow-creatiires  live,  and  in  no  way  more  thau  in  mitigating 
some  of  the  horrcrs  of  disease ;  but  we  are  too  apt  to  forget 
that  apart  from  and  beyond  her  domain  lie  those  irresistible 
forces  which  alone  sway  the  hearts  of  men.    V.'itn  reason 
science  never  parts  company,  but  with  feeling,  emotion, 
passion,  what  has  she  to  do  ?    They  are  not  of  her ;  they 
owe  her  no  allegiance.  She  may  study,  analyze,  and  define, 
she  can  never  control  them,  and  by  no  possibilty  can  their 
ways  be  justified  to  her.    The  great  philosopher  who  took 
such  a  deep  interest  in  the  foundation  of  this  University, 
chained  the  lightnings,  but  who  has  chained  the  wayward 
spirit  of  man?    Strange  compound,  now  wrapt  in  the 
ecstasy  of  the  beatific  vision,  now  wallowing  in  the  sloughs 
of  iniquity,  no  leaven,  earthly  or  divine,  aas  worked  any 
permanent  change  m  him.    Listen  to  the  words  of  a  student 
of  the  heart  of  man,  a  depictor  of  his  emotions :  "  In  all 
ages  the  reason  of  the  world  has  been  at  the  ii.«5rcy  of  brute 
force.    The  reign  of  law  has  never  had  more  than  a  passing 
reaUty,  and  never  can  have  more  than  that  so  long  as  man 
is  human.    The  individual  intellect,  and  the  aggregate 
intelligence  of  nations  and  races,  have  alike  perished  in  the 
struggle  of  mankind,  to  revive  again,  indeed,  but  as  surely 
to  be  again  put  to  the  edge  of  the  sword.    Look  where 
you  will  throughout  the  length  and  breadth  of  all  that  was 
the  world,  5000  or  500  years  ago ;  everywhere  passion  has 
swept  thought  before  it,  and  belief,  reason.    Passion  rules 
the  world,  and  rules  alone.    And  passion  is  neither  of  the 
head  nor  of  the  hand,  but  of  the  heart.    Love,  hate,  ambi- 
tion, anger,  avarice,  either  make  a  slave  of  intelligence  to 
serve  their  impulses,  or  break  down  its  impotent  opposition 

99 


Mdb 


MUflHfa 


THE  LEAVEN  OF  SCIENCE 

with  the  unanswerable  argument  of  brute  force,  and  tear 
it  to  pieces  with  iron  hands."    (Marion  Crawford.) 

Who  runs  may  read  the  scroll  which  reason  has  placed 
as  a  warning  over  the  human  menageries :  "  chained,  not 
tamed."  And  yet  who  can  doubt  that  the  leaven  of  science, 
working  in  the  individual,  leavens  in  some  slight  degree 
the  whole  social  fabric.  Reason  is  at  least  free,  or  nearly 
so ;  the  shackles  of  dogma  have  been  removed,  and  faith 
herself,  freed  from  a  morganatic  alliance,  finds  in  the  release 
great  gain. 


H' 


1 


il 


One  of  the  many  fertile  fancies  of  the  "  laughing  phil- 
osopher," a  happy  anticipation  again  of  an  idea  peculiarly 
modern,  was  that  of  the  influence  upon  us  for  weal  or  woe 
of  Externals,  of  the  idola,  images,  and  effluences  which 
encompass  us — of  Externals  upon  which  so  much  of  our 
happiness,  yes,  so  much  of  our  every  character  depends.  The 
trend  of  scientific  thought  in  this,  as  in  the  atomic  theory, 
has  reverted  to  the  Sage  of  Abdera ;  and  if  environment 
really  means  so  much,  how  all-important  a  feature  in  educa- 
tion must  be  the  nature  of  these  encompassing  effluences. 
This  magnificent  structure,  so  admirably  adapted  to  rhe 
prosecution  of  that  science  from  which  modern  thought 
has  drawn  its  most  fruitful  inspirations,  gives  completeness 
to  the  already  exhilarating  milieu  of  this  University.  Here 
at  last,  and  largely  owing  to  your  indomitable  energy, 
Mr.  Provost,  are  gathered  all  the  externals  which  make  up 
a  Schda  major  worthy  of  this  great  Commonwealth.  What, 
after  all,  is  education  but  a  subtle,  slowly-afEected  change, 
due  to  the  action  upon  us  of  the  Externals  ;  of  the  written 
record  of  the  great  minds  of  all  ages,  of  the  beautiful  and 

100 


THE  LEAVEN   OF  SCIENCE 

harmonious  surroundings  of  nature  and  of  art,  and  of  the 
lives,  good  or  ill,  of  our  fellows— these  alone  edu'^ate  us, 
these  alone  mould  the  developing  minds.  Within  the 
bounds  of  this  campus  these  influences  will  lead  successive 
generations  of  youth  from  matriculation  in  the  college  to 
graduation  in  the  special  school,  the  complex,  varied  in- 
fluences of  Art,  of  Science,  and  of  Charity ;  of  Art,  the 
highest  development  of  which  can  only  come  with  that 
sustaining  love  for  ideals  which,  "  burns  bright  or  dim  as 
each  are  mirrors  of  the  fire  for  which  all  thirst ;  "  of  Science, 
the  cold  logic  of  which  keeps  the  mind  independent  and 
Iree  from  the  toils  of  self-deception  and  half-knowledge ; 
of  Charity,  in  which  we  of  the  medical  profession,  to  walk 
worthily,  must  live  and  move  and  have  our  being. 


101 


\\fi 


]  I 


VI 


THE  ARMY  SURGEON 


loa 


I!  < 


Nor  Mare  his  sword  nor  war's  quick  fire  shall  bum 

The  living  record  of  your  memory. 

'Gainst  death  and  all-obliTious  enmity 

ShaU  you  pace  forth ;  your  praise  shall  stiU  6nd  room 

Kven  in  the  eyes  of  all  posterity. 

Shakispiabe.  SonneU,  LV. 


104 


VI 

THE  ARMY  SURGEON' 

AT  the  outset  I  am  sure  you  will  permit  mt,  on  >w>half 
of  the  profession,  to  offer  to  the  Army  Medical 
Department  hearty  congratulations  on  the  completion 
of  the  arrangements   which   have   made   possible    this 
gathering.    With  capacities  strained  to  the  utmost  in 
furnishing  to  students  an  ordinary  medical  education, 
the  schoob  at  large  cannot  be  expected  to  equip  aiaiy 
surgeons  wilh  the   full   details  of  special   training.    A 
glance   at   the   curriculum   just   comp'^ted   brings   into 
sharp  relief  the  dipabilities  under  which  previous  classes 
must  have  proceeded  to  their  labours,  the  members  of 
which  have  had  to  pick  up  at  random — in  many  cases 
have    probably    never    acquired — the    valuable    know- 
ledge traversed  in  the  lectures  and  laboratory  exercises 
of  the  session.    But  greatest  of  all  the  advantages  of  an 
army  medical  school  must  be  counted  the  contact  of 
the  young  officers  with  their  seniors,  with  the  men  under 
whose  directions  they  subsequently  have  to  work.    In 
comparison  with  their  predecessors,  with  what  different 
feelings  and  ideas  will  the  men  before  us  enter  upon  their 
duties  in  the  various  posts  to  which  they  have  been  assigned. 
In8+«ad  of  hazy  notions — perhaps  to  one  fresh  from  the 
Examining  Board  not '  leasant  ones— of  a  central  authority 
at  Washington,  of  a  Yama  enthroned  as  Secretary  of 

»  Army  Medical  School,  Washington,  February  28,  1894. 

105 


\0': 


mil 


i  r    ' 


il 


t  f  I 


THE  ARMY  SURGEON 

War,  and  of  an  exacting  Surgeon'Greneral,  the  young 
officer  who  has  enjoyed  the  delightful  opportunities  of 
four  months'  study  amid  these  inspiring  surroundings, 
which  teem  with  reminders  of  the  glories  of  the  corps 
and  of  the  greatness  of  his  profession,  the  young  officer, 
I  say,  must  be  indeed  a  muddy-mettled  fellow  who  does 
not  carry  away,  not  alone  rich  stores  of  information,  but, 
most  precious  of  all  educational  gifts,  a  true  ideal  of  what 
his  life-work  should  be. 

Members  of  the  Graduating  Class:  Though  to  you  it 
may  not,  to  me  it  seems  peculiarly  appropriate  that  the 
Surgeon-General  should  have  asked  a  civilian  to  make 
an  address  on  this  occasion.  With  the  strictly  military 
aspects  of  your  future  life  you  Lave  made  yourselves 
familiar;  of  the  merits  and  demerits  of  the  army  as  a 
career  for  a  physician  you  have  in  the  past  four  months 
heard  very  much ;  but  about  all  subjects  there  are  some 
questions  which  are  more  freely  handled  by  one  who  is 
unhampered  by  too  particular  knowledge,  and  this  is 
my  position,  I  may  say  my  advantage,  to-day.  For  me 
the  Army  Medical  Department,  so  far  as  particulars  are 
concerned,  means  a  library  with  unsurpassed  facilities, 
the  worth  of  which  is  doubled  by  the  liberality  of  its 
management ;  a  museum  in  which  I  have  spent  some 
delightful  hours ;  an  index-catalogue,  which  is  at  my 
elbow  like  a  dictionary ;  and  the  medical  history  of  the 
late  V  particularly  the  volumes  by  Woodward  and 
Smart.  Further,  in  my  general  reading  in  the  history  of 
the  profession  of  this  country,  I  have  here  and  there 
gleaned  facts  about  the  corps  and  its  members.  I  have 
lead  the  spir.ted  vindication  of  John  Morgan,  who  may 

106 


THE  ARMY  SURGEON 

be  called  the  first  Surgeon-General,  and  I  am  faailiar 
with  the  names  and  works  of  many  of  your  distinguished 
predecessors  who  have  left  their  mark  in  our  literature. 

But  as  I  write  an  aspiration  of  the  past  occurs,  bringing 
me,  it  seems,  closer  to  you  than  any  of  the  points  just 
mentioned,  a  recollection  of  the  days  when  the  desire 
of  my  life  was  to  enter  the  India  Medical  Service,  a  dream 
of  youth,  dim  now  and  almost  forgotten— a  dream  of 
"  Vishnu  land,  what  Avatar  !  " 

Speaking,  then,  from  the  vantage  ground  of  my  ignor- 
ance, let  me  tell  you  briefly  of  the  opportunities  of  the 
life  you  have  chosen.  First  among  your  privileges  I 
shall  place  a  feature  often  spoken  of  as  a  hardship,  viz., 
the  frequent  change  from  station  to  station.  Permanence 
of  residence,  good  undoubtedly  for  the  pocket,  is  not 
always  best  for  wide  mental  vision  in  the  physician. 
You  are  modern  representatives  of  a  professional  age 
long  past,  of  a  day  when  physicians  of  distinction  had 
no  settled  homes.  You  are  Cyprid  larvae,  unattached, 
free-swimming,  seeing  much  in  many  places ;  not  fixed, 
as  we  barnacles  of  civil  life,  head  downward,  degenerate 
descendants  of  the  old  professional  Cirripeds,  who  laid 
under  contribution  not  one,  but  a  score  of  cities. 

Without  local  ties,  independent  of  the  public,  in,  while 
not  exactly  of,  our  ranks,  you  will  escape  many  of  the 
anxieties  which  fret  the  young  physician— the  pangs  of 
disprized  worth,  the  years  of  weary  waiting,  the  uncer- 
tainty of  the  effort;  and  perhaps  those  sorer  trials  in- 
evitable in  an  art  engaging  equally  heart  and  head,  in 
which,  from  the  very  nature  of  the  occupation,  the  former 
is  apt— in  finer  spirits— to  be  touched  with  a  grievoua 

107 


.' '  ■ 


I 


\0' 


I'  1= 


r  n 


THE   ARMY  SUPGEON 

sensibility.  In  change,  that  leaven  of  life  denied  to  so 
many,  you  will  find  a  strong  corrective  to  some  of 
the  most  unpleasant  of  the  foibles  which  beset  us.  Self- 
satisfaction,  a  frame  of  mind  widely  diffused,  is  manifest 
often  in  greatest  intensity  where  it  should  be  least  en- 
couraged, and  in  individuals  and  communities  is  some- 
times so  active  on  such  slender  grounds  that  the  condi- 
tion is  comparable  to  the  delusions  of  grandeur  in  the 
insane.  In  a  nomad  life  this  common  infirmity,  to  the 
entertainment  of  which  the  twin  sisters.  Use  and  Wont, 
lend  their  ever-ready  aid,  will  scarcely  touch  you,  and 
for  this  mercy  give  thanks ;  and  while  you  must,  as 
men,  entertain  many  idols  of  the  tribe,  you  may  at  least 
escape  this  idol  of  the  cave.  Enjoying  the  privilege  of 
wide  acquaintance  with  men  of  very  varied  capabilities 
and  traming,  you  can,  as  spectators  of  their  many  crotchets 
and  of  their  little  weaknesses,  avoid  placing  an  undue 
estimate  on  your  own  individual  powers  and  position. 
As  Sir  Thomas  Browne  says,  it  is  the  "  nimbler  and  con- 
ceited heads  that  never  looked  a  degree  beyond  their 
nests  that  tower  and  plume  themselves  on  light  attain- 
ments," but  "  heads  of  capacity  and  such  as  are  not 
full  with  a  handful  or  easy  measure  of  knowledge  think 
they  know  nothing  till  they  know  all ! " 

Per  contra,  in  thus  attaining  a  broader  mental  platform, 
you  may  miss  one  of  the  great  prizes  of  the  profession 
—a  position  m  a  community  reached  in  length  of  days 
by  one  or  two,  who,  having  added  to  learning,  culture, 
to  wisdom,  charity,  pass  the  evening  of  their  lives  in 
the  hearts  of  their  colleagues  and  of  their  kind.  No  gift 
of  Apollc.not  the  Surgeon-Generalship,  not  distinguished 

108 


THE   ARMY   SURGEON 

position  in  science,  no  professorship,  however  honoured, 
can  equal  this,  this  which,  as  wandering  Army  Surgeons, 
you  must  furego.    Fortunate  is  it  for  you  that  the  service 
in  one  place  is  never  long  enough  to  let  the  roots  strike 
so  deeply  as  to  make  the  process  of  transplantation  too 
painful.    Myself  a  peripatetic,  I  know  what  it  is  to  bear 
the  scars  of  partings  from  comrades  and  friends,  scars  which 
sometimes  ache  as  the  memories  recur  of  the  days  which 
have  flown  and  of  the  old  familiar  faces  which  have  gone. 
Another  aspect  of  the  life  of  the  Army  Surgeon,  isolation 
in  some  degree  from  professional  colleagues,  will  influence 
you  in  different  ways— hurtfully  in  the  more  dependent 
natures,  helpfully  in  those  who  may  have  learned  tkat 
"not  from  without  us,  only  from  within  comes,  or  can 
ever  come,  upon  us  light  "—and  to  such  the  early  years 
of  separation  from  medical  societies  and  gatherings  will 
prove  a  useful  seed-time  for  habits  of  study,  and  for  the 
cultivation  of  the  self-reliance  that  forms  so  important  an 
element  in  the  outfit  of  the  practitioner.    And,  after  all, 
the  isolation  is  neither  so  enduring  nor  so  corroding  as 
might  have  fallen  to  your  lot  in  the  routine  of  country 
practice.    In  it  may  be  retained,  too,  some  measure  of 
individuality,  lost  with  astonishing  rapidity  in  the  city 
mills  that  rub  our  angles  down  and  soon  stamp  us  all  alike. 
In  the  history  of  the  profession  there  are  grounds  for  the 
statement  that  isolation  promotes  originality.    Some  of 
the  most  brilliant  work  has  been  done  by  men  in  extremely 
lim'  .d  spheres  of  action,  and  during  the  past  hundred 
ye£  i-s  it  is  surprising  how  many  of  the  notable  achievements 
have  been  made  by  physicians  dwelling  far  from  educational 
centres — Jenner  worked  out  his  discovery  in  a  village ; 

109 


N   i 


THE  ARMY  SURGEON 
McDowell,  Long,  and  Sims  were  country  doctors ;  Koch 
was  a  district  physician. 

So  much  depends  upon  the  sort  of  start  that  a  man 
makes  in  his  profession  that  I  cannot  refrain  from  con- 
gratulating you  again  on  the  opportunities  enjoyed  durmg 
the  past  four  months,  which  have  not  only  added  enor- 
mously to  your  capabilities  for  work,  but  have  familiarized 
vnu  with  Ufe  at  the  heart  of  the  organization  of  which 
uereafter  you  wiU  form  part,  and  doubtless  have  given 
you  fruitful  ideas  on  the  possibilities  of  your  individual 
development.  NaturaUy  each  one  of  you  will  desire  to 
make  the  best  use^of  his  talents  and  education,  and  let  me 
sketch  briefly  what  I  think  should  be  your  plan  of  action. 

Throw  away,  in  the  first  place,  all  ambition  beyond 
that  of  doing  the  day's  work  weU.    The  traveUers  on 
the  road  to  success  live  in  the  present,  heedless  of  taking 
thought  for  the  morrow,  having  been  able  at  some  time, 
and  in  some  form  or  other,  to  receive  into  their  heart  of 
hearts  this  maxim  of  the  Sage  of  Chelsea  :  Your  business 
is  "  not  to  see  what  Ues  dimly  at  a  distance,   but  to  da 
what  lies  clearly  at  hand."    Fevered  haste  is  not  en- 
couraged m  mUitary  circles,  and  if  you  can  adapt  your 
inteUectual  progress  to  army  rules,  making  each  step  in 
your   mental   promotion   the   lawful   successor   of  some 
other,  you  wiU  acquire  little  by  little  those  staying  powers 
without  which  no  man  is  of  much  value  in  the  ranks. 
Your  opportunities  for  study  will  cover  at  first  a  wide 
field  in  medicine  and  surgery,  and  this  diffuseness  in 
your  work  may  be  your  salvation.    In  the  next  five  or 
ten  years  note  with  accuracy  and  care  everything  that 
comes  within  your  profpsaional  ken.    There  are,  in  truth, 

110 


I      t 


THE   AlvMY   SURGEON 

no  specialties  in  medicine,  since  to  know  fully  many 
of  the  most  important  diseases  a  man  must  be  familiar 
with  their  manifestations  in  many  organs.  Let  nothing 
slip  by  you  ;  the  ordinary  humdnmi  cases  of  the  morning 
routine  may  have  been  accurately  described  and  pictured, 
but  study  each  one  separately  as  though  it  were  new— 
80  it  is  so  far  as  your  special  experience  goes  ;  and  if  the 
spirit  of  the  student  is  in  you  the  lesson  will  be  there. 
Look  at  the  cases  not  from  the  standpoint  of  text-books 
and  monographs,  but  as  so  many  stepping-stones  in  the 
progress  of  your  individual  development  in  the  art.  This 
will  save  you  from  the  pitiable  mental  attitude  of  the  men 
who  travel  the  road  of  practice  from  Dan  to  Beersheba, 
and  at  every  step  cry  out  upon  its  desolation,  it  dreariness, 
and  its  monotony.    With  Laurence  Sterne,  in  afford 

to  pity  such,  since  they  know  not  that  t..  barrenness 
of  which  they  complam  is  within  themselves,  a  result  of 
a  lack  of  appreciation  of  the  meaning  and  method  of  work. 
In  the  early  years  of  service  your  advantages  will  be 
fuDy  as  great  as  if  you  had  remained  in  civil  life.  Faith- 
fulness in  the  day  oi  small  things  will  insensibly  widen 
your  powers,  correct  your  faculties,  and,  in  moments  of 
despondency,  comfort  may  be  derived  from  a  knowledge 
that  some  of  f  it  work  of  the  profession  has  come  from 
men  whose  ci  .  field  wm  I'r  ited  but  well-tilled.  The 
important  thing  is  to  make  the  lesson  of  each  case  tell 
on  your  education.  The  value  of  experience  is  not  in 
seemg  much,  but  in  seeing  wisely.  Experience  in  the 
true  sense  of  the  term  does  not  come  to  all  with  years, 
or  with  increasing  opportunities.  Growth  in  the  acquisi- 
tion of  facts  is  not  necessarily  associated  with  develop- 
Ill 


'•. 


1 


I 


R 


./•• 


!! 


I: 


\      i 


IBE  ARMY  SURGEON 
ment.    Many  grow  through  life  mentally  as  the  crystal, 
by  simple  accretion,  and  at  fifty  possess,  to  vary  the 
figure,   the   unicellular   mental    blastoderm   with   which 
they  started.    The  gro%/th  which  is  organic  and  enduring, 
is  totally  different,  marked  by  changes  of  an  unmistakable 
character.    The   observations   are    made   with   accuracy 
and  care,  no  pains  are  spared,  nothing  is  thought  a  trouble 
in  the  investigation  of  a  problem.    The  facts  are  looked 
at  in  connexion  with  similar  ones,  their  relation  to  others 
is  studied,  and  the  experience  of  the  recorder  is  compared 
with  that  of  others  who  have  worked  upon  the  question. 
Insensibly,  year  by  year,  a  man  finds  that  there  has  been 
in  his  mental  protoplasm  not  only  growth  by  assimilation 
but  an  actual  development,   brmging  fuller  powers   of 
observation,  additional  capabilities  of  mental  nutrition, 
and  that  mcreased  breadth  of  view  which  is  of  the  very 
essence  of  wisdom. 

As  clinical  observers,  we  study  the  experiments  which 
Nature  makes  upon  our  fellow-creatures.  These  experi- 
ments, however,  in  striking  contrast  to  those  of  the 
laboratory,  lack  exactness,  possessing  as  thc^  do  a  vari- 
bility  at  once  a  despair  and  a  delight— the  despair  of  those 
who  look  for  nothing  but  fixed  laws  in  an  art  which  is 
still  deep  in  the  sloughs  of  Empiricism  ;  the  delight  of 
those  who  find  in  it  an  expression  of  a  universal  law 
transcending,  even  scorning,  the  petty  accuracy  of  test- 
tube  and  balance,  the  law  that  in  man  "  the  measure  of 
all  things,"  mutability,  variability,  mobility,  are  the  very 
marrow  of  his  being.  The  dientele  in  which  you  work 
has.  however,  more  stability,  a  less  extended  range  of 
variation  than  that  with  which  we  deal  in  civil  life.    In 

112 


4 


THE   ARMY   SUROEON 

a  body  of  carefully  selected  active  young  men,  you  have 
a  material  for  study  in  which  the  oscillations  are  less 
striking,  and  in  which  the  results  of  the  experiments,  i.e., 
the  diseases,  have  a  greater  uniformity  than  in  infancy 
and  old  age,  in  the  enfeebled  and  debauched.    This  adds 
a  value  to  the  studies  of  army  medical  officers,  who  often 
have    made    investigations    in    hygiene,    dietetics,    and 
medicine,  so  trustworthy  and  thorough  that  they  serve 
us  as  a  standard  of  comparison,  as  a  sort  of  abscissa  or 
base-line.    Thus  you  have  demonstrated  to  us,  and  to 
the  community  at  large,  the  possibilities  of  stamping  out 
BtQallpox  by  systematic  revaccinat'on ;  in  civil  practice 
we  strive  to  reach  the  low  rate  of  mortality  of  army 
hospitals  in  the  treatment  of  typhoid  fever  and  of  f  :eumonia. 
Many  of  the  most  important  facts  relating  to  etiology 
and  symptomatology  have  come  from  camp  or  barrack. 
I  often  think  that  army  surgeons  scarcely  appreciate  that 
in  their  work  they  may  follow  the  natural  history  of  a 
disease  under  the  most  favourable  circumstances ;    the 
experiments  are  more  ideal,  the  conditions  less  disturbing 
than  those  which  prevail  either  in  family  practice  or  in 
the  routine  of  the  general  hospital.    Many  of  the  common 
disorders  can  be  tracked  from  inception  to  close,  as  can 
be  done  in  no  other  line  of  medical  work,  and  the  facilities 
for  the  continuous  study  of  certain  affections  are  un- 
equalled.   This,  which  is  a  point  to  be  appreciated  in  the 
intrinsic  education  of  which  I  spoke,  gives  you  a  decided 
advantage  over  your  less  favoured  brethren. 

Your  extraordinary  range  of  observation,  from  the 
Florida  Keys  to  Montana,  from  Maine  to  Southern  Cali- 
fornia, affords  unequalled  facilities  for  the  study  of  many 

AE.  lis  I 


ill 


if 


'il 


i  ^^ 


II    !' 


i   I ; 


THE  ARMY  SURGEON 
oi  the  vexed  problems  in  medicine— facilities,  indeed, 
which  in  the  diversity  of  morbid  conditions  to  be  studied 
are  equalled  in  no  position  in  civil  Ufe.    Let  me  here 
mention  a  few  of  the  subjects  that  may  profitably  engage 
your  attention.    No  question  is  of  more  importance  at 
present  than  the  settlement,  definitely,  of  the  varieties  of 
fever  in  the  West  and  South.    The  studies  of  Baumgarten 
in  St.  Louis,  and  of  Guiteras  and  others  in  the  Southern 
States,  suggest  the  possibility  that  in  addition  to  typhoid 
fever   and   malaria— the   common   affections— there    are 
other  fevers  the  symptomatology  and  morbid  anatomy 
of  which  still  require  careful  elucidation.    In  this  you 
will  be  walking  in  the  footsteps  of  notable  predecessors 
in  the  corps,  and  in  the  exhaustive  works  of  Woodward 
and  Smart,  to  which  I  have  already  alluded,  and  which 
are  always  available,  you  will  find  a  basis  from  which 
you  may  start  your  personal  observations.    More  par- 
ticularly in  this  direction  do  we  need  careful  anatomical 
investigation,   since  the  symptomatology  of  certain  of 
the  affections  in  question  has  much  in  common  with  that 
of  the  ordinary  continued  fevers  of  the  North.    I  may 
call  your  attention  to  the  satisfactory  settlement  of  the 
nature  of  mountam  fever  by  army  surgeons,  and  need 
hardly  add  that  the  specimens  contributed  by  Hofi  and 
by  Girard  to  this  museum  demonstrate  conclusively  that 
it  is  in  reality  typhoid  fevc  . 

In  the  Southern  posts  malaria  with  its  protean  mani- 
festations presents  still  many  interesting  problems  for 
solution,  and  you  will  leave  this  school  better  equipped 
than  any  of  your  predecessors  for  the  study  and  difieren- 
tiation  of  its  less  known  varieties.    With  positive  know- 

114 


Miiill 


■M 


THE  ARMY  SXJRGEON 

ledge  as  to  the  etiology,  and  a  practical  familiarity  with 
methods  of  blood-examination,  you  can  do  much  in  many 
localities  to  give  to  malaria  a  more  definite  position  than 
it  at  present  occupies  in  the  profession,  and  can  o£Eer 
in  doubtful  cases  the  positive  and  satisfactory  test  of  the 
microscope.  The  hsematuria  of  the  South  requires  to  be 
studied  anew — ^^  e  filarial  cases  separated  from  the  malarial, 
and,  most  important  of  all,  the  relation  of  quinine  to 
hematuria  positively  set+led. 

In  the  more  (distant  posts,  where,  so  far  as  the  soldier 
is  concerned,  your  opportunities  for  study  may  be  limited,- 
you  n\ay  add  greatly  to  our  knowledge  of  the  disorders 
prevalent  among  the  Indians.  More  particularly  do  we 
need  additional  information  as  to  the  frequency  of  tubercu- 
losis among  them,  and  its  clinical  history.  One  of  your 
number,  Dr.  Edwards,  has  already  furnished  admirable 
statistics  upon  this  point,  but  the  field  is  still  open,  and 
much  remains  to  be  done.  In  this  connexion,  too,  you 
may  be  able  to  carry  saving  knowledge  upon  the  etiology 
of  the  disease,  and  enforce  regulations  for  its  prevention. 
You  have  only  to  turn  to  the  Index-catalogue  to  see  how 
scanty  in  reality  are  the  facts  in  the  nosology  of  the  North 
American  Indian. 

At  many  posts  there  will  be  presented  to  you  the 
interesting  effects  of  altitude,  with  problems  of  the  greatest 
physiological  importance.  An  excellent  piece  of  work  may 
be  done  upon  its  influences  upon  the  red  blood-corpuscles, 
in  determining  whether,  as  has  been  maintained,  there 
is  an  increase  numerically  per  cubic  millimetre,  so  long 
as  the  individual  remains  in  the  more  rarefied  atmosphere. 
Points  remain  to  be  settled  also  upon  the  effects  of  altitude 

115 


^ 


THE  ARMY  SURGEON 

upon  the  chest-capacity,  the  chest-measurement.  and  the 
heart,  and  our  knowledge  is  stUl  lacking  on  questions 
reUting  to  the  influence  of  high  altitudes  upon  many  of 
the  ordinary  diseases. 

To  one  of  you,  perhaps,  another  peculiarly  American 
disease— milk-sickness— may  reveal  its  secret.  Our  know- 
ledge of  its  etiology  has  not  been  materially  increased 
since  the  early  papers  on  the  subject,  which  so  weU 
described  its  symptomatology. 

These  are  but  a  few  of  the  questions  suggesting  them- 
selves to  my  mind,  to  which,  as  chance  affords,  you  could 
direct  your  attention.  In  a  ten  or  fifteen  years'  service, 
traveUing  with  seemg  eyes  and  hearmg  ears,  and  carefuUy- 
kept  note-books,  just  think  what  a  store  house  of  climcal 
material  may  be  at  the  command  of  any  one  of  you- 
material  not  only  valuable  in  itself  to  the  profession,  but 
of  infinite  value  to  you  personally  in  its  acquisition,  render- 
ing you  painstaking  and  accurate,  and  giving  you,  year  by 
year,  an  increasing  experience  of  the  sort  to  which  I  have 
already  more  than  once  referred. 

In  what  I  have  said  hitherto  I  have  dwelt  chiefly  on 
your  personal  development,  and  on  the  direction  in  which 
your  activities  might  be  engaged,  but  while  you  are  thus 
laying  the  foundation  of  an  education  in  all  that  relates 
to  the  technical  side  of  ;-e  profession,  there  are  other 
duties  which  caU  for  a  word  or  two.    In  the  commumties 
to  which  you  may  be  sent  do  not  forget  that,  though 
army  officers,  you  owe  allegiance  to  an  honourable  pro- 
fession, to  the  members  of  which  you  are  linked  by  ties 
of  a  most  binding  character.    In  situations  in  which  the 
advantages  of  a  more  critical  training  give  you  a  measure 

116 


i 


THE  ARMY  SURGEON 

of  superiority  over  your  confrires  in  civil  life,  let  it  not 
be  apparent  in  your  demeanour,  but  so  order  yourselves 
that  in  all  things  you  may  appear  to  receive,  not  to  grant 
favours.    There  are  regions,   in  partihus  infiddium,  to 
which  you  will  go  as  missionaries,  carrying  the  gospel  of 
loyalty  to  truth  in  the  science  and  in  the  art  of  medicine, 
and  your  lives  of  devotion  may  prove  to  many  a  stimu- 
lating example.    You  cannot  afford  to  stand  aloof  from 
your  professional  colleagues  in   any  place.    Join  their 
associations,  mingle  in  their  meetings,  giving  of  the  best 
of  your  talents,  gathering  here,  scattering  there;    but 
everywhere  showing  that  you  are  at  all  times  faithful 
students,  as  willing  to  teach  as  to  be  taught.    Shun  as 
most  pernicious  that  frame  of  mind,  too  often,  I  fear, 
seen  in  physicians,  which  assumes  an  air  of  superiority 
and  limits  as  worthy  of  your  communion  only  those  with 
satisfactory  collegiate  or  sartorial  credentials.    The  pass- 
ports to  ycuT  fellowship  should  be  honesty  of  purpose 
and  a  devotion  to  the  highest  interests  of  our  profession, 
and  these  you  will  find  widely  diffused,  sometimes  appa-ent 
only  when  you  get  beneath  the  crust  of  a  rough  exterior. 
If  I  have  laid  stress  upon  the  more  strictly  professional 
aspects  of  your  career  it  has  been  with  a  purpose.    I 
believe  tho  arrangements   in   the  departm-^nt  are   such 
that,  witft  habit    jf  ordinary  diligence,  each  one  of  you 
may  attain  not  only  a  high  grade  of  personal  development, 
but  may  become  an  important  contributor  in  the  advance- 
ment of  OUT  art.    I  have  said  nothing  of  the  pursuit 
of  the  sciences  cognate  to  medicine,  of  botany,  zoology, 
geology,    ethnology   nnd    archaeology.  In   every   one   of 
these,  so  fascinating  in  themselves,  it  is  true  that  army 

117 


I 


>f 


I'  i 


M 


I 


' 


THE  ARMY  SURGEON 
medical  offioen  have  risen  to  distinction,  bat  I  claim 
that  your  first  duty  is  to  medicine,  which  should  have  your 
best  services  and  your  loyal  devotion.  Not,  too,  in  the 
perfunctory  discharge  of  the  daily  routine,  but  in  zealous 
endeavour  to  keep  pace  with,  and  to  aid  in,  the  progress 
of  knowledge.  In  this  way  you  will  best  serve  the  depart- 
ment, the  profession,  and  the  public. 

Generalities,  of  the  kind  in  which  I  have  been  indulging, 
though  appropriate  to  the  occasion,  are  close  kin,  I  ^eP", 
to  the  fancies  fond,  that  vanish  like  the  gay  motes  which 
float  for  a  moment  in  the  sunbeams  of  our  mind.  But 
I  would  fain  leave  with  you,  in  closing,  something  of  a 
more  enduring  kind— a  picture  that  for  me  has  always 
had  a  attraction,  the  picture  of  a  man  who, 

amid    cu.  ^s    the    most    unfavourable,    saw    his 

opportunity  u  i  quick  to  "  grasp  the  skirts  of  happy 

chance."    Far  away  in  the  northern  wilds,  where  the 
waters  of  Lake  Michigan  and  Lake  Huron  unite,  stands 
the  fort  of  Michilimackinac,  rich  in  memories  of  Indian 
and  voyageur,  one  of  the  four  important  posts  on  the 
upper  lakes  in  the  days  when  the  Rose  and  the  Fleur-de-lis 
strove   for   the   mastery   of  the   Western   worid.    Here 
was  the  scene  of  Marquette's  mission,  and  here  beneath 
the  chapel  of  St.  Ignace  they  laid  his  bones  to  rest.    Here 
the  intrepid  La  Salle,  the  brave  Tonty,  and  the  resolute 
Du  Lhut  had  halted  in  their  wild  wanderings.    Its  palisades 
and  bastions  had  echoed  the  war-whoops  of  Ojibwas  and 
Ottawas,   of  Hurons  and   Iroquois,   and  had  been  the 
scene   of   bloody   massacres   and   of  hard-fought  fights. 
At  the  conplusion  of  the  war  of  1812,  after  two  centuries 
of  struggle,  peace  settled  at  last  upon  the  old  fort,  and 

118 


m^t 


THE   ARMY  SURGEON 

early  in  her  reign  celebrated  one  of  the  most  famous  of 
her  minor  victories,  one  which  carried  the  high-sounding 
name  of  Michilimackinac  far  and  wide,  and  into  circles 
where  Marquette,  Du  Lliut  and  La  Salle  were  unknown. 
Here,  in  1820,  was  assigned  to  duty  at  the  fort,  which  had 
been  continued  in  use  to  keep  the  Indians  in  check.  Surgeon 
William  Beaumont,  then  a  young  man  in  the  prime  of  life. 
On  June  22,  1822,  the  accidental  discharge  of  a  musket 
made  St.  Martin,  a  voyageur,  one  of  the  most  famous 
subjects  in  the  history  of  physiology,  for  the  wound  laid 
open  his  stomach,  and  he  recovered  with  a  permanent 
gastric  fistula  of  an  exceptionally  favourable  kind.    Beau- 
mont was  not  slow  to  see  the  extraordinary  possibilities 
that  \7ere  before  him.    Early  in  the  second  decade  of  the 
century  the  process  of  gastric  digestion  was  believed  to 
be  due  to  direct  mechanical  maceration  or  to  the  action 
of  a  vital  principle,  and  though  the  idea  of  a  solvent 
juice  had  long  been  entertained,  the  whole  question  was 
sub  judice.    The  series  of  studies  made  by  Beaumont  on 
St.  Martin  settled  for  ever  the  existence  of  a  solvent  fluid 
capable  of  acting  on  food  outside  as  well  as  within  the 
body,  and  in  addition  enriched  our  knowledge  of  the 
processes  of  digestion  by  new  observations  on  the  move- 
ments of  the  stomach,  the  temperature  of  the  interior  of 
the  body,  and  the  digestibility  of  the  various  articles  of 
food.    The  results  of  his  work  were  published  in  1833, 
in  an  octavo  volume  of  ^ss  than  300  pages.'    In  looking 
through  it  one  cannot  but  recognize  that  it  is  the  source 

»  Experimenta  and  Observations  on  the  Oaatrie  Juice  and  the 
Physiology  of  Digestion.  By  William  Beaumont.  M.D.,  Surgeon  in 
the  United  Statea  Armv-    Plattsburg.    1833. 

119 


1     !' 


U 


w  i 


r" 


THE  ARMY  SURGEON 
of  a  very  large  part  of  the  current  statements  about 
digestion ;  but  apart  altogether  from  the  value  of  the  facts, 
there  are  qualities  about  the  work  which  make  it  a  model 
of  its  kind,  and  on  every  page  is  revealed  the  character 
of  the  man.    From  the  first  experiment,  dated  August  1, 
1825,  to  the  last,  dated  November  1,  1833,  the  observa- 
tions are  made  with  accuracy  and  care,  and  noted  in 
plain,   terse   language.    A   remarkable   feature   was  the 
persistence  with  which  for  eight  years  Beaumont  pursued 
the  subject,  except  during  two  intervals  when  St.  Martin 
escaped  to  his  relatives  in  Lower  Canada.    On  one  occasion 
Beaumont  brought  him  a  distance  of  two  thousand  miles 
to  Fort  Crawford,  on  the  upper  Mississippi,  where,  in  1829, 
the  second  series  of  experiments  was  made.    The  third 
series  was  conducted  in  Washington,  in  1832 ;    and  the 
fourth  at  Plattsburg  in  1833.    The  determination  to  sift 
the  question  thoroughly,  to  keep  at  it  persistently  until 
the  truth  was  reached,  is  shown  in  every  one  of  the  238 
experiments  which  he  has  recorded. 

The  opportunity  presented  itself,  the  observer  had  the 
necessary  mental  equipment  and  the  needed  store  of 
endurance  to  carry  to  a  successful  termination  a  long 
and  laborious  research.  William  Beaumont  is  indeed 
a  bright  example  in  the  annab  of  the  Army  Medical 
Department,  and  there  is  no  name  on  its  roll  more  deserving 
to  live  in  the  memory  of  the  profession  of  this  country. 

And  in  closing  let  me  express  the  wish  that  each  one 
of  you,  in  all  your  works  begun,  continued  and  ended, 
may  be  able  to  say  with  him:  "Truth,  like  beauty, 
'  when  unadorned  is  adorned  the  most,'  and  in  prosecuting 
experiments  and  inquiries  I  believe  I  have  been  guided 

by  its  light." 

120 


f 


1! 


vn 

TEACHING  AND  THINKING 


I 


I 


131 


L«t  us  then  blush,  in  this  so  ample  and  so  wonderful  field  of 
L«t  UB  men  uiuoi ,  „xop«wia  what  is  promised),  to 

'leaner  liiigs  to  higher,  we  shall  at  length  1.  rooe.ved  mto  her 
Ooset-^r^te^  to  Anatomical  ExmiMions  concerning  the  Generation 
of  Lirnng  Creatures.  1653.  ^^^^  ^^^^ 


122 


'•i: 


vn 


TEACHING  AND  THINKING  ' 


The  Two  Func 


OF  A  Medical  School 


\ 


i 

MANY  things  have  been  urged  against  our  nineteenth 
century  civilization — that  political  enfranchise! 
ment  only  ends  in  anarchy,  that  the  widespread  unrest  in 
spiritual  matters  leads  only  to  unbelief,  and  that  the  best 
commentary  on  our  boasted  enlightenment  is  the  picture 
of  Europe  in  arms  and  the  nations  everywhere  gnarring  at 
each  other's  heels.  Of  practical  progress  in  one  direction, 
however,  there  can  be  no  doubt ;  no  one  can  dispute  the 
enormous  increase  in  the  comfort  of  each  individual  life. 
Collectively  the  human  race,  or  portions  of  it  at  any  rate, 
may  in  the  past  have  enjoyed  periods  of  greater  repose,  and 
longer  intervals  of  freedom  from  strife  and  anxiety ;  but 
the  day  has  never  been  when  the  unit  has  been  of  such 
value,  when  the  man,  and  the  ^an  alone,  has  been  so  much 
the  measure,  when  the  individual  as  a  living  organism  has 
seemed  so  sacred,  when  the  obligations  to  regard  his  rights 
have  seemed  so  imperative.    But  even  these  changes  are 


»  McGill  Medical  School,  October  1,  1894. 
123 


I J 


TEACHING  AND  THINKING 

as  nothing  in  comparison  with  the  ^^^^ff^^^'^^^.^ 
his  physical  weU-being.  The  bitter  cry  of  Isaiah  that  with 
the  multiplication  of  the  nations  their  joys  had  not  been 
increased.  stiU  echoes  in  our  ears.  The  sorro^  and  troubks 
of  men.  it  i.  -  ..  may  not  have  been  ^-^^^^^ ^"^"^^^ 
but  bodUy  pain  and  sufiering.  though  not  abolished,  have 
been  assuaged  as  never  before,  and  the  share  of  each  m  the 
Wdtschmerz  has  been  enormously  lessened. 

Sorrows  and  griefs  are  companions  sure  sooner  or  later 
to  join  us  on  our  pilgrimage,  and  we  have  become  perhaps 
more  sensitive  to  them,  and  perhaps  less  amenable  to  he 
old  time  remedies  of  tte  physicians  of  the  soul :  but  the 
pains  and  woes  of  the  body,  to  which  we  doctors  mimster 
L  decreasing  at  an  extraordinary  rate,  and  m  a  way  that 
makes  one  fairly  gasp  in  hopeful  anticipation. 

In  his  Gramtmr  of  AsserU,  in  a  notable  passage  on 
suffering,  John  Henry  Newman  asks.  "  Who  can  weigh  and 
measure  the  aggregate  of  pain  which  this  one  generation 
has  endured,  and  will  endure,  irom  birth  to  dea  h  ?    Then 
add  to  this  aU  the  pain  which  has  fallen  and  will  fall  upon 
our  race  through  centuries  past  and  to  come       But  take 
the  other  view  of  it-think  of  the  Nemesis  which  has  over- 
taken pain  during  the  past  fifty  years !    Anesthetics  and 
antiseptic  surgery  have  almost  manacled  the  demon  and 
since  their  introduction  the  aggregate  of  pam  which  _  as 
been  prevented  far  outweighs  in  civUized  commumties  that 
which  has  been  suffered.    Even  the  curse  of  travail  has 
been  lifted  from  the  soul  of  women. 

The  greatest  art  is  in  the  concealment  of  art,  and  1  may 
say  that  we  of  the  medical  profession  excel  in  this  respect. 
You  of  the  pubUc  who  hear  me.  go  about  the  duties  of  the 

124 


TEACHING  AND  THINKING 
day  profoundly  indifEerent  to  the  facts  I  have  just  men- 
tioned. You  do  not  know,  many  of  you  do  not  care,  that 
for  the  cross-legged  Juno  who  presided  over  the  arrival  of 
your  grandparents,  there  now  nits  a  benign  and  straight- 
legged  goddess.  You  take  it  for  granted  that  if  a  shoulder 
is  dislocated  there  is  chloroform  and  a  delicious  Ne^  onthe 
instead  of  the  agony  of  the  pulleys  and  paraphernalia  of 
fifty  years  ago.  You  accept  with  a  selfish  complacency,  as 
if  you  were  yourselves  to  be  thanked  for  it,  that  the  arrows 
of  destruction  fly  not  so  thickly,  and  that  the  pestilence 
now  rarely  valketh  in  the  darkness;  stiix  less  do  ycu 
realize  that  you  may  now  pray  the  prayer  of  Hezekiah  with 
a  reasonable  prc.pect  of  its  fulfilment,  since  modern  science 
has  made  to  almost  everyone  of  you  the  present  of  a  few 
years. 

I  say  you  do  not  know  these  things.  You  hear  of  them, 
and  the  more  intelligent  among  you  perhaps  ponder  them 
in  your  hearts,  but  they  are  among  the  things  which  you 
take  for  granted,  like  the  sunshine,  and  the  flowers  and  the 
glorious  heavens. 

'Tis  no  idle  challenge  which  we  physicians  throw  out  to 
the  world  when  we  claim  that  our  mission  is  of  the  highest 
and  of  the  noblest  kind,  not  alone  in  curing  disease  but  in 
educating  the  people  in  the  laws  of  health,  and  in  preventing 
the  spread  of  plagues  and  pestilences ;  nor  can  it  be  gain- 
said that  of  late  years  ov.r  record  as  a  body  has  been  more 
encouraging  in  its  practical  results  than  those  of  the  other 
learned  professions.  Not  that  we  all  live  up  to  the  highest 
ideals,  far  from  it — we  are  only  men.  But  we  have 
ideals,  which  mean  much,  and  they  are  realizable,  which 
means  more.    Of  course  there  are  Gehazis  among  us  who 

125 


N 


TEACHING  AND  THINKING 

serve  for  shekels,  whose  ears  hear  only  the  lowing  of  the 
oxen  and  the  jingling  of  the  guineas,  but  these  are  excep- 
tions.  The  rank  and  file  labour  earnestly  for  your  good, 
and  self-sacrificing  devotion  to  your  interests  animates  our 

best  work. 

The  exercises  in  which  we  are  to-day  engaged  form  an 
incident  in  this  beneficent  work  which  is  in  progress 
everywhere;  an  incident  which  will  enable  me  to  dwell 
upon  certain  aspects  of  the  university  as  a  factor  in  the 
promotion  of  the  physical  veil-being  of  the  race. 

II 
A  great  university  has  a  dual  function,  to  teach  and  to 
think.    The  educational  aspects  at  first  absorb  all  its 
energies,  and  in  equippmg  various  departments  and  pro- 
viding salaries,  it  finds  itself  hard  pressed  to  fulfil  even  the 
first  of   these  duties.      The  story  of  the  progress  of  the 
medical  school  of  this  institution  illustrates  the  struggles 
and  difficulties,  the  worries  and  vexations  attendant  upon 
the  effort  to  place  it  in  the  first  rank  as  a  teaching  body.    I 
know  them  well,  since  I  was  in  the  thick  of  them  for  ten 
years,  and  see  to-day,  the  realization  of  many  of  my  day- 
dreams.   Indeed  in  my  wildest  flights  I  never  thought 
to  s»e  such  a  splendid  group  of  buUdings  as  I  have  just 
inspected.    We  were  modest  in  those  days,  and  I  remember 
when  Dr.  Howard  showed  me  in  great  confidence  the  letter 
of  the  Chancellor,  in  which  he  conveyed  his  first  generous 
bequest  to  the  Faculty,  it  seemed  so  great  that  in  my  joy 
I  was  almost  ready  to  sing  my  Num  dimUtis.     The  great 
advances  here,  at  the  Montreal  General  Hospital,  and  at 
the  Royal  Victoria  (both  of  which  institutions  form  most 

126 


TEACHING   AND   THINKING 

easential  parts  of  the  medical  schools  of  this  city)  mean 
increased  teaching  facilities,  and  of  necessity  better 
equipped  graduates,  better  equipped  doctors!  Here  is 
the  kernel  of  the  whole  matter,  and  it  is  for  this  that  we 
ask  the  aid  necessary  to  build  large  laboratories  and  large 
hospitals  in  which  the  student  may  learn  the  science  and 
art  of  medicine.  Chemistry,  anatomy  and  physiology  give 
that  perspective  which  enables  him  to  place  man  and  his 
diseases  in  their  proper  position  in  the  scheme  of  life,  and 
afford  at  the  same  time  that  essential  basis  upon  which 
alone  a  trustworthy  experience  may  be  built.  Each  one 
of  these  is  a  science  in  itself,  complicated  and  difficult, 
demanding  much  time  and  labour  for  its  acquisition,  so 
that  in  the  few  years  which  are  given  to  their  study  the 
student  can  only  master  the  principles  and  certain  of  the 
facts  upon  which  they  are  founded.  Only  so  far  as  they 
bear  upon  a  due  understanding  of  the  phenomena  of  disease 
do  these  subjects  form  part  of  the  medical  curriculum,  and 
for  us  they  are  but  means — essential  means  it  is  true — to 
this  end.  A  man  cannot  become  a  competent  surgeon 
without  a  full  knowledge  of  human  anatomy  and  physiology, 
and  the  physician  without  physiology  and  chemistry 
flounders  along  in  an  aimless  fashion,  never  able  to  gain  any 
accurate  conception  of  disease,  practising  a  sort  of  pop- 
gun pharmacy,  hitting  now  the  malady  and  again  the 
patient,  he  himself  not  knowing  which. 

The  primary  function  of  this  department  of  the  univer- 
sity is  to  instruct  men  about  disease,  what  it  is,  what  are  its 
manifestations,  how  it  may  be  prevented,  and  how  it  may 
be  cured  ;  and  to  learn  these  things  the  four  hundred  young 
men  who  sit  on  these  benches  have  come  from  all  parts  of 

127 


TEACHING  AND  THINKING 

the  land.    But  it  iB  no  light  r-ponribiUty  "If  ^  » f"d^ 
tl«  in  thi.  matter.    The  t«k  is  be»t  w>th  d.fflo«H  «. 

rlinherent  in  the  object  ^^^^l^^Z^ 
Mlve.  while  not  a  lew  are  oaneed  by  the  laoK  oi  ™'™' 
«^in  medioal  matte™  of  the  people  among  whom  we 

'^C;:L.  0.  ai«.«  are  eo  complex  that  it  i.  e^- 
rively  Leult  to  .».teh  out  the  law,  which  control  them 
r^  aSugh  we  have  eeen  a  complete  evolution  m  our 
Z.  wha^has  been  accomplished  by  the  new  school  of 
Se  is  only  an  earnest  o.  what  the  titure  h»  .n^«. 
The  three  jreat  advances  of  the  century  has  been  a  know 
Xrhe'LodeofcontroUingepidemicdise.ses.them^ 

dSon  of  an<esthetic,.  and  the  adoption  of  ant«pt^ 
'nSl  in  su^ery.    Beside  them  aU  others  «nkm^ 
•     -fi^n^^P   ««  these  three  contribute  so  enc  mousiy  xo 
Z'^^-frof  the  individual.    The  study  of  the 
tZZ  so-called  infectious  disoriers  has  led  ^r^^J» 
the  discovery  of  the  methods  for  their  control,  for  example, 
*chTroSe  as  typhoid  fever  becomes  almost  unknown 
r^e  rretnce  of  ^rfect  drainage  and  an  uncontamimited 
It  ^Zlv     The  outlook,  too,  for  specific  methods  of 
::!"  t  tbese  affections  is  most  hopeful.    The  pu  he 
Zrit  be  discouraged  by  a  few,  or  even  by  many 
Z^    Z  tUnkers  who  are  doing  the  work  for  you  are 
rrJtpath,anaHisn„vain^cyth^^^^^^^^ 
twentieth  century  is   very  old  there  may 
Ta^ines  against  many  of  the  contagious  diseases^ 

R.,t  a  shrewd  old  feUow  remarked  to  me  the  other  day, 
..  Z  rX  aisea.es  are  less  frequent,  others  l.ve  ^p- 
pe.^  out  new  ones  are  alw^  croppmg  up.  and  I  notice 


B     V      1 


TEACHING   AND  THINKING 

that  with  it  all  there  is  not  only  no  decrease,  but  a  very 
great  increase  in  the  number  of  doctors." 

The  total  abolition  of  the  infectious  group  we  cannot 
expect,  and  for  many  years  to  come  there  will  remain 
hosts  of  bodily  ills,  even  among  preventable  maladies,  to 
occupy  our  labours ;  but  there  are  two  reasons  which  ex- 
plain the  relative  numerical  increase  in  the  profession  in 
spite  of  the  great  decrease  in  the  number  of  certain  diseases. 
The  development  of  specialties  has  given  employment  to 
many  extra  men  who  now  do  much  of  the  work  of  the  old 
family  practitioner,  and  again  people  employ  doctors  more 
frequently  and  so  give  occupation  to  many  more  than 
formerly. 

It  cannot  be  denied  that  we  have  learned  more  rapidly 
how  to  prevent  than  how  to  cure  diseases,  but  with  a 
definite  outline  of  our  ignorance  we  no  longer  live  now  in  a 
fool's  Paradise,  and  fondly  imagine  that  in  all  cases  we 
control  the  issues  of  life  and  death  with  our  pills  and 
potions.  It  took  tht  profession  many  generations  to  learn 
that  fevers  ran  their  course,  influenced  very  little,  if  at  all, 
by  drugs,  and  the  £60  which  old  Dover  complained  were 
spent  in  drugs  in  a  case  of  ordinary  fever  about  the  middle 
of  the  last  century  is  now  better  expended  on  a  trained 
nurse,  with  infinitely  less  risk,  and  with  infinitely  greater 
comfort  to  the  patient.  Of  the  difficulties  inherent  in  the 
art  not  one  is  so  serious  as  this  which  relates  to  the  cure  of 
disease  by  drugs.  There  is  so  much  uncertainty  and  discord 
even  among  the  best  authorities  (upon  non-essentials  it  is 
true)  that  I  always  feel  the  force  of  a  well-known  stanza  in 
Rabbi  Ben  Ezra— 


▲E; 


129 


TEACHING  AND  THINKING 

Now,  who  shall  arbitrate? 

Ten  men  love  what  I  hate. 

Shun  what  I  foUow,  slight  what  I  receive; 

Ten,  who  in  ears  and  eyes 

Match  me:  we  all  Burmise.  i^iuv«  ? 

They  this  thing,  and  I  that :  whom  shaU  my  soul  beUevo  ? 

One  of  the  chief  reaa  for  this  uncertainty  is  the  in- 
creasing variaoility  in  tuo  manifestations  of  any  one  dis- 
ease. As  no  two  faces,  so  no  two  cases  are  ahke  m  all 
respects,  and  unfortunately  it  is  not  only  the  disease  itself 
which  is  so  varied,  but  the  subjects  themselves  have 
peculiarities  which  modify  its  action. 

With  the  diminished  reliance  upon  drugs,  there  has  been 
a  return  with  profit  to  the  older  measures  of  diet,  exercise, 
baths,  and  frictions,  the  remedies  with  which  the  Bithynian 
Asclepiades  doctored  the  Romans  so  successfully  in  the 
first  century.  Though  used  less  frequently,  medicines  are 
now  given  with  infinitely  greater  skill ;  we  know  better 
their  indications  and  contradictions,  and  we  may  safely 
say  (reversing  the  proportion  of  fifty  years  ago)  that  for 
one  damaged  by  dosing,  one  hundred  are  saved. 

Many  of  the  difficulties  which  surround  the  subject  relate 
to  the  men  who  practise  the  art.    The  commonest  as  well 
as  the  saddest  mistake  is  to  mistake  one's  profession, 
and  this  we  doctors  do  often  enough,  some  of  us,  without 
knowing  it.    There  are  men  who  have  never  had  the  pre- 
liminary education   which  would  enable  them  to  grasp 
the  fundamental  truths  of  the  science  on  which  medicine 
is  based.    Others  have  poor  teachers,  and  never  receive  that 
bent  of  mind  which  is  the  aU  important  factor  in  education ; 
others  again  faU  early  into  the  error  of  thinking  that  they 
know  it  aU,  and  benefiting  neither  by  their   mistakes  or 

130 


H 


TEACHING   AND   THINKING 

their  succeaaes,  miss  the  very  essence  of  a)'  experience,  and 
die  bigger  fools,  if  possible,  than  when  they  started. 
There  are  only  two  sorts  of  doctors ;  those  who  practise 
with  their  brains,  and  those  who  practise  with  their  tongues. 
The  studious,  hard-working  man  who  wishes  to  know  his 
profession  thoroughly,  who  lives  in  the  hospitals  and  dis- 
pensaries, and  who  strives  to  obtain  a  wide  and  philoso- 
phical conception  of  disease  and  its  processes,  often  has  a 
hard  struggle,  and  it  may  take  years  of  waiting  before  he 
becomes  successful ;  but  such  form  the  bulwarks  of  our 
ranks,  and  outweigh  scores  of  the  voluble  Cassios  who  talk 
themselves  into,  and  often  out  of,  practice. 

Now  of  the  difficulties  bound  up  with  the  public  in  which 
we  doctors  work,  I  hesitate  to  speak  in  a  mixed  audience. 
Common  sense  in  matters  medical  is  rare,  and  is  usually  in 
inverse  ratio  to  the  degree  of  education.  I  suppose  as  a 
body,  clergymen  are  better  educated  than  any  other,  yet 
they  arc  notorious  supporters  of  all  the  nostrums  and 
humbuggery  with  which  tLv.  daily  and  religious  papers 
abound,  and  I  find  that  the  further  away  they  have  wan- 
dered from  the  decrees  of  the  Council  of  Trent,  the  more 
apt  are  they  to  be  steeped  in  thaumaturgic  and  Galenical 
superstition.  But  know  also,  man  has  an  inborn  cravin^ 
for  medicine.  Heroic  dosing  for  several  generations  has 
given  hi?  tissues  a  thirst  for  drugs.  As  I  once  before 
remarked,  the  desire  to  take  medicine  is  one  feature  which 
distinguishes  man,  the  animal,  from  his  fellow  creatures.  It 
is  really  one  of  the  most  serious  difficulties  with  which  we 
have  to  contend.  Even  in  minor  ailmonts,  which  would 
yield  to  dieting  or  to  simple  home  remedies,  the  doctor's 
visit  is  not  thought  to  be  complete  without  the  prescription. 

131 


TEACHING  AND  THINKING 

And  now  that  the  phannaciBte  have  cloaked  even  the  most 
nauseous  remedies,  the  temptation  U  to  use  medicme  on 
every  occasion,  and  I  fear  we  may  return  to  that  »tete  °! 
polypharmacy,  the  emancipation  from  which  has  been  the 
Bole  gift  of  Hahnemami  and  his  followers  to  the  race.    As 
the  public  becomes  more  enlightened,  and  as  we  get  more 
sense,  dosing  will  be  recognized  as  a  very  minor  function  m 
the  practise  of  medicine  in  comparison  with  the  old  measures 
of  Asclepiades.  . 

After  aU.  these  difficulties-in  the  subject  itself,  m  us. 
and  in  you-are  lessening  gradually,  and  we  have  the 
consolation  of  knowing  that  year  by  year  the  total  amount 
of  unnecessary  suffering  is  decreasing  at  a  rapid  rate 

In  teaching  men  what  disease  is.  how  it  may  be  pre- 
vented,  and  how  it  may  be  cured,  a  University  i.  fulfiUmg 
one  of  its  very  noblest  functions.    The  wise  instruction 
and  the  splendid  example  of  such  men  as  Holmes  Suther- 
land. Campbell.  Howard.  Ross.  Macdonnell.  and  others  have 
carried  comfort  into  thousands  of  homes  throughout  this 
land     The  benefits  derived  from  the  increased  facihties  for 
the  teaching  of  medicine  which  have  come  with  the  great 
changes  made  here  and  at  the  hospitals  during  the  past 
few  years,  will  not  be  confined  to  the  citizens  of  this  town 
but  will  be  widely  diffused  and  felt  in  every  locality  to  which 
the  graduates  of  this  school  may  go  ;  and  every  gift  which 
promotes  higher  medical  education,  and  which   enables 
the  medical  faculties  throughout  the  country  to  turn  out 
better  doctors,  means  fewer  mistakes  in  diagnosis,  greater 
skill  in  dealing  with  emergencies,  and  the  saving  of  pam 
and  anxiety  to  countless  sufferers  and  their  friends. 
The  physician  needs  a  clear  head  and  a  kind  heart ;  hia 
*^  182 


TEACHING   AND  THINKING 

work  is  arduous  and  complex,  requiring  the  exercise  of  the 
very  highest  faculties  of  the  rrind  '  'e  constantly  appeal- 
ing to  the  emotions  and  finer  fee'  At  no  time  has  his 
influence  been  more  pot^.  *  lan  at  present,  at  no  time  has 
he  b.-»en  so  powerful  a  factor  for  good,  and  as  it  is  one  of  the 
highest  possible  duties  of  a  great  University  to  fit  men  for 
this  calling,  so  it  will  be  your  highest  mission,  students  of 
medicine,  to  carry  on  the  never-ending  warfare  against 
disease  and  death,  better  equipped,  abler  men  than  your 
predecessors,  but  animated  with  their  spirit  and  sustained 
by  their  hopes.  "  for  the  hope  of » very  creature  is  the  banner 
that  we  bear." 

Ill 

The  other  function  of  a  University  is  to  think.  Teaching 
current  knowledge  in  all  departments,  teaching  the  steps 
by  which  the  status  prcBsens  has  been  reached,  and  teaching 
how  to  teach,  form  the  routine  work  of  the  various  college 
faculties.  All  this  may  be  done  in  a  perfunctory  manner 
by  men  who  have  never  gone  deeply  enough  into  the  sub- 
jects to  know  that  really  thinking  about  them  is  in  any  way 
necessary  or  important.  What  I  mean  by  the  thinking 
function  of  a  University,  is  that  duty  which  the  professional 
corps  owes  to  enlarge  the  boundaries  of  human  knowledge. 
Work  of  this  sort  makes  a  University  great,  and  alone 
enables  it  to  exercise  a  wide  influence  on  the  minds  of  men. 

We  stand  to-day  at  a  critical  point  in  the  history  of  this 
faculty.  The  equipment  for  teaching,  to  supply  which  has 
taken  years  of  hard  struggle,  is  approaching  completion, 
and  with  the  co-operation  of  the  General  and  the  Royal 
Victoria  Hoapitab  students  cati  obtain  in  all  branches  a 

183 


U  ! 


TEACHING  AND  THINKING 

thorough  training.    We  have  now  reached  a  position  in 
which  the  higher   university  work  may  at  any  rate  be 
discussed,  and  towards  its  progress  in  the  future  must 
trend     It  may  seem  to  be  discouraging,  after  so  much  has 
been  done  and  so  much  has  been  so  generously  given,  to 
say  that  there  remains  a  most  important  function  to  foster 
and  sustain,  but  this  aspect  of  the  question  must  be  con- 
sidered when  a  school  has  reached  a  certain  stage  of  develop- 
ment    In  a  progressive  institution  the  changes    come 
slowly,  the  pace  may  not  be  perceived  by  those  most  con- 
cerned except  on  such  oc-,asions  as  the  present,  which  serve 
as  land-marks  in  its  evolution.    The  men  and  methods 
of  the  old  Cot6    street  school    were  better  than  those 
with  which  the  faculty  started ;  we  and  our  ways  at  the 
new  building  on  University  street  were  better  than  those 
of  Cote  street ;  and  now  you  of  the  present  faculty  teach  and 
work  much  better  than  we  did  ten  years  ago.    Everywhere 
the  old  order  changeth,  and  happy  those  who  can  change 
with  it.  Like  the  defeated  gods  in  Keats's  "  Hyperion,"  too 
many  unable  to  receive  the  balm  of  the  truth,  resent  the 
wise  words  of  Oceanus  (which  I  quoted  here  with  very 
different  feelings  some  eighteen  years  ago  in  an  introductory 

lecture). 

So  on  our  heels  a  fresh  perfection  treads, 

*****        bom  of  us 

And  fated  to  excel  us. 
Now  the  fresh  perfection  which  will  tread  on  our  heels 
will  come  with  the  opportunities  for  higher  university 
work.  Let  me  indicate  in  a  few  words  its  scope  and  aims. 
Teachers  who  teach  current  knowledge  are  not  necessarily 
investigators ;  many  have  not  had  the  needful  training  r 

134 


TEACHING  AND   THINKING 


I 


others  have  not  the  needful  time.  The  very  best  instructor 
for  students  may  have  no  conception  of  the  higher  lines  of 
work  in  his  branch,  and  contrariwise,  how  many  brilliant 
investigators  have  been  wretched  teachers  ?  In  a  school 
which  has  reached  this  stage  and  wishes  to  do  thinking  as 
well  as  teaching,  men  must  be  selected  who  are  not  only 
thoroughly  au  courant  with  the  best  work  in  their  depart- 
ment the  world  over,  but  who  also  have  ideas,  with  am- 
bition and  energy  to  put  them  into  force — men  who  can  add 
each  one  in  his  sphere,  to  the  store  of  the  world's  knowledge. 
Men  of  this  stamp  alone  confer  greatness  upon  a  university. 
They  should  be  sought  for  far  and  wide  ;  an  institution  which 
wraps  itself  in  Strabo's  cloak  and  does  not  look  beyond  the 
college  gates  in  selecting  professors  may  get  good  teachers, 
but  rarely  good  thinkers. 

One  of  the  chief  difficulties  in  the  way  of  advanced  work 
is  the  stress  of  routine  class  and  laboratory  duties,  which 
often  sap  the  energies  of  men  capable  of  higher  things.  To 
meet  this  difficulty  it  is  essential,  first,  to  give  the  professors 
plenty  of  assistance,  so  that  they  will  not  be  worn  out  with 
teaching  ;  and,  secondly,  to  give  encouragement  to  gradu- 
ates and  others  to  carry  on  researches  under  their  direction. 
With  a  system  of  fellowships  and  research  scholarships  a 
university  may  have  a  body  of  able  young  men,  who  on  the 
outposts  of  knowledge  are  exploring,  surveying,  defining 
and  correcting.  Their  work  is  the  outward  and  visible 
sign  that  a  university  is  thinking.  Surrounded  by  a  group 
of  bright  young  minds,  well  trained  in  advanced  methods, 
not  only  is  the  professor  himself  stimulated  to  do  his  best 
work,  but  he  has  to  keep  far  afield  and  to  know  what  is 
stirring  in  every  part  of  his  own  domain. 

135 


ii  ' 


TEACHING  AND  THINKING 
With  the  wise  co-operation  of  the  university  and  the 
hospital  authorities  Montreal  may  become  the  Edinburgh 
of  America,  a  great  medical  centre  to  which  men  wiU  flock 
for  sound  learning,  whose  laboratories  will  attract  the 
ablest  students,  and  whose  teaching  wiU  go  out  into  all 
lands,  universally  recognized  as  of  the  highest  and  of  the 

best  type. 

Nowhere  is  the  outlook  more  encouraging  than   at 
McGill.    What  a  guarantee  for  the  future  does  the  pro- 
gress of  the  past  decade  afiord  !    No  city  on  this  continent 
has  endowed  higher  education  so  liberally.    There  remains 
now  to  foster  that  undefinable  something  which,  for  want 
of  a  better  term,  we  caU  the  university  spirit,  a  something 
which  a  rich  institution  may  not  have,  and  with  which  a 
poor  one  may  be  saturated,  a  something  which  is  associated 
with  men  and  not  with  money,  which  cannot  be  purchased 
in  the  market  or  grown  to  order,  but  which  comes  insensibly 
with  loyal  devotion  to  duty  and  to  high  ideals,  and 
without  which  Nehushtan  is  written  on  the  portals    of 
any  school  of  Medicine,  however  famous. 


186 


i'M 


VIII 

NTERNAL  MEDICINE  AS  A 
VOCATION 


H. 

I! 


187 


A  physician  in  i  great  city  seems  to  be  the  mere  playthmg  of 
fortune  ;  his  degree  of  reputation  -.  for  the  most  part  totally  casual ; 
they  that  employ  him  know  not  his  excellence  ;  they  that  reject 

him  know  not  his  deficience. 

Samxtel  Johnson. 

It  happens  to  us,  aa  it  happeneth  to  wayfaring  men :  sometimes 
our  way  is  clean,  sometimes  foul ;  sometimes  up  hill,  sometimes 
down  hiU ;  we  are  seldom  at  a  certainty ;  ihe  wind  is  not  always 
at  our  backs,  nor  is  every  one  a  friend  that  we  meet  in  the  way. 

Bunyan's  Pilgrim's  Progress,  Part  II. 

In  the  mind,  as  in  the  body,  there  is  the  necessity  of  getting  rid 
of  waflt«,  and  a  man  of  active  Uteraiy  habits  will  write  for  the  fire 

as  well  as  for  the  prtis. 

JxKOME  Cardan. 


t 


188 


mat 


■■IH 


VIII 


INTERNAL  MEDICINE  AS  A 
VOCATION ' 


IT  was  with  the  greatest  pleasure  that  I  accepted  an 
invitation  to  address  this  section  of  the    Academy 
on  the  importance  of  internal  mec'icine  es   a    vocation. 
I  wish  there  were  another  term  to  designate   the    wide 
field  of  medical  practice  which  remains  after  the  separation 
of   surgery,  midwifery,    and   gynaecology.    Not    itself   a 
specialty  (though  it  embraces  at  least  half  a  dozen),  its 
cultivators  cannot  be  called  specialists,  but  bear  without 
reproach  the  good  old  name  physician,  in  contradistinction 
to   general    practitioners,    surgeons,     obstetricians,    and 
gynaecologists.    I  have  heard  the  fear  expressed  that  in 
this  country  the  sphere  of  the  physician  proper  is  becoming 
more  and  more  restricted,  and  perhaps  this  is  true  ;  but  I 
maintain  (and  I  hope  to  convince  you)  that  the  oppor- 
tunities are  still  great,  that  the  harvest  truly  is  plenteous, 
and  the  labourers  scarcely  sufficient  to  meet  the  demand. 
At  the  outset  I  would  like  to  emphasize  the  fact  that 
the  student  of  internal  medicine  cannot  be  a  specialist. 
The  manifestations  of  almost  any  one  of  the  important 
diseases  in  the  course  of  a  few  years  will  "  box  the  com- 
pass" of  the  specialties.    Typhoid  fever,  for  example, 
will  not  only  go  the  rounds  of  those  embraced  in  medicine 
I  New  York  Academy  of  Medicine,  1897. 
189 


i 


U 


INTERNAL  MEDICINE  AS  A  VOCATION 
proper,  but  wiU  carry  its  student  far  afield  in  morbid 
psychology,  and  sometimes  teach  him,  perhaps  at  the 
cost  oi  the  patient,  a  little  surgery.  So,  too,  with  syphihs, 
which  after  the  first  few  weeks  I  claim  as  a  medical  affection. 
I  often  teU  my  students  that  it  is  the  only  disease  which 
they  require  to  study  thoroughly.  Know  syphUis  m  all 
its  manifestations  and  relations,  and  all  other  things 
clinical  will  be  added  unto  you. 

Each  generation  has  to  grow  its  own  consultants.   Hos- 
sack,  Samuel  MitchiU,  Swett,  Alonzo  Clark,  Austin  Flint. 
Fordyce  Barker,  and  Alfred  Loomis,  sei-ved  their  day  m 
this  city,  and  then  passed  on  into  sUence.    Their  works 
remain  ;  but  enough  of  a  great  physician's  experience  dies 
with  him  to  justify  the  saying  "  there  is  no  wisdom  m  the 
grave."    The  author  of  Rab  and  His  Friends  has  a  couple 
oi  paragraphs  on  this  point  which  are  worth  quoting : 
'  Much  that  made  such  a  man  what  the  community,  to 
their  highest  profit,  found  to  him  be,  dies  with  him.    His 
inborn  gifts,  and  much  of  what  was  most  valuable  m  his 
experience,  were  necessarily  incommunicable  to  others; 
this  depending  much  on  his  forgetting  the  process  by 
which,  in  particular  cases,  he  made  up  his  mind,  and  its 
minutie  successive  steps,  ....  but  mainly,  we  beUeve, 
because  no  man  can  explain  directly  to  another  man  how 
he  does  any  one  practical  thing,  the  doing  of  which  he 
himself  has  accomplished  not  at  once  or  by  imitation, 
or  by  teaching,  but  by  repeated  personal  trials,  by  missing 
much  before  ultimately  hitting." 

Wherewithal  shall  a  young  man  prepare  himself,  should 
the  ambition  arise  in  him  to  follow  in  the  footsteps  of  such 
a  teacher  as,  let  us  say,  the  late  Austin  Flint-the  young 

140 


1 


INTERNAL  BIEDICINE  AS  A  VOCATION 

man  just  starting,  and  who  will  from  1915  to  1940  stand 
in  relation  to  the  profession  of  this  city  and  this  country 
as  did  Dr.  Flint  between  1861  and  the  time  of  his  death. 
We  will  assume  that  he  starts  with  equivalent  advantages, 
though  this  is  taking  a  great  deal  for  granted,  since  Austin 
Flint  had  a  strong  hereditary  bias  toward  mediciiie,  and 
early  in  life  fell  under  the  Influence  of  remarkable  men 
whose  teachings  moulded  his  thought  to  the  very  end. 
We  must  not  forget  that  Dr.  Flint  was  a  New  Englander, 
and  of  the  same  type  of  mind  as  his  great  teacLers— 
James  Jackson  and  Jacob  Bigelow. 

Our  future  consultant  has  just  left  the  hospital,  whero, 
for  the  first  time  realizmg  the  possibilities  of  his  profession, 
he  has  had  his  ambition  fired.  Shall  he  go  abroad  ?  It 
is  not  necessary.  The  man  whom  we  have  chosen  as  his 
exemplar  did  not,  but  found  his  opportunities  in  country- 
practice,  in  Bufialo  and  Louisville,  then  frontier  towns, 
and  in  New  Orleans,  and  had  a  national  reputation  before 
he  reached  New  York.  But  would  it  be  useful  to  him  ? 
Undoubtedly.  He  will  have  a  broader  foundation  on 
which  to  build,  and  a  year  or  two  in  the  laboratories  and 
clinics  of  the  great  European  cities  will  be  most  helpful. 
To  walk  the  wards  of  Guy's  or  St.  Bartholomew's,  to  see 
the  work  at  the  St.  Louis  and  at  the  Salpetriere,  to  spend 
a  few  quiet  months  of  study  at  one  of  the  German  uni- 
versity towns  will  store  the  young  man's  mind  with  price- 
less treasures.  I  assume  that  he  has  a  mind.  I  am  not 
heedlees  of  the  truth  of  the  sharp  taunt — 


How  much  the  fool  that  hath  been  sent  to  Rome, 
Exceeds  the  fool  that  hath  been  kept  at  home. 

141 


f 


U 


II    : 


'« 


INTERNAL  MEDlCirE   AS   A   VOCATION 
At  any  rate,  whether  he  goes  abroad  or  not,  let  him  early 
escape  from  the  besetting  sin  of  the  young  physician, 
ChaZinism,  that  intolerant  attitude  of  mind,  which  brooks 
no  regard  for  anything  outside  his  o^vn  circle  and  his  own 
school.    If  he  camiot  go  abroad  let  him  spend  part  of  his 
short  vacations  in  seeing  how  it  fares  with  the  brethren  m 
his  own  country.    Even  a  New  Yorker  could  learn  some- 
thing in  the  Massachusetts  General  and  the  Boston  City 
Hospitals.    A  trip  to  Philadelphia  would  . .  ^  >it  helpful ; 
there  is  much  to  stimulate  the  mind  at  the  old  Pemisylvania 
Hospital  and  at  the  University,  and  he  would  be  none  the 
wor^  for  a  few  weeks  spent  still  farther  south  on  the  banks 
of  the  Chesapeake.    The  aU-important  matter  is  to  ge 
breadth  of  view  as  early  as  possible,  and  this  is  difficult 

without  travel. 

Poll  the  successful  consulting  physicians  of  this  country 
to-day,  and  you  will  find  they  have  been  evolved    either 
from  general  practice  or  from  laboratory  and  clinical  work : 
many  of  the  most  prominent  having  risen  from  the  ranks 
of  general  practitioners.    I  once  heard  an  eminent  con- 
sultant rise  in  wrath  because  some  one  had  made  a  remark 
reflecting  upon  this  class.    He  declared  that  no  single 
part  of  his  professional  experience  had  been  of  such  value. 
But  I  wish  to  speak  here  of  the  training  of  men  who  start 
with  the  object  of  becoming  pure  physicians.    From  the 
vantage  ground  of  more  than  forty  years  of  hard  work. 
Sir  Andrew  Clark  told  me  that  he  had  striven  ten  years 
for  bread,  ten  years  for  bread  and  butter,  and  twenty 
years  for  cakes  and  ale ;  and  this  is  really  a  very  good 
partition  of  the  life  of  the  student  of  internal  medicine, 
of  some  at  least,  since  all  do  not  reach  the  last  stage. 

142 


■■A 


INTERNAL   MEDICINE   AS  A   VOCATION 

It  is  high  time  we  had  our  young  Lydgatc  started.'  If 
he  has  shown  any  signs  of  nous  during  hlo  student  and 
hospital  days  a  dispensary  assistantship  should  be  avail- 
able ;  anything  should  be  acceptable  which  brings  him 
into  contact  with  patients.  By  all  means,  if  possible,  let 
him  be  a  pluralist,  and — as  he  values  his  future  life — let 
him  not  get  early  entangled  in  the  meshes  of  specialism. 
Once  established  as  a  clinical  assistant  he  can  begin  his 
education,  and  nowadays  this  is  a  very  complicated 
matter.  There  are  three  lines  of  work  which  he  may 
follow,  all  of  the  most  intense  interest,  all  of  the  greatest 
value  to  him — chemistry,  physiology,  and  morbid  anatomy. 
Professional  chemists  look  askance  at  physiological 
chemistry,  and  physiological  chemists  criticize  pretty 
sharply  the  work  of  some  clinical  chemists,  but  there  can 
be  no  doubt  of  the  value  to  the  physician  of  a  very  thorough 
training  in  methods  and  ways  of  organic  chemistry.  We 
sorely  want,  in  this  coimtry,  men  of  this  line  of  training, 
and  the  outlook  for  them  has  never  before  been  so  bright. 
If  at  the  start  he  has  not  had  a  good  chemical  training, 
the  other  lines  should  be  more  closely  followed. 

Physiology,  which  for  him  will  mean  very  largely  ex- 
perimental therapeutics  and  experimental  pathology, 
will  open  a  wider  view  and  render  possible  -•,  deeper  grasp 
of  the  problems  of  disease.  To  Traube  and  men  of  his 
stamp,  the  physiological  clinicians,  this  generation  owes 
much  more  than  to  the  chemical  or  post-mortem'ioom 
group.    The  training  is  more  difficult  to  get,  and  now- 


i  This  well-drawn  character  in  George  Eliot's  Middlemarch  may 
be  studied  with  advantage  by  the  physician ;  one  of  the  most 
imponant  lessons  to  be  gathered  from  it  ia — marry  the  right  woman ! 

143 


1^^ 


v\ 


m 


It. 


M 
i 


i. 


INTERNAL  MEDICINE  AS  A  VOCATION 
^y,.  ,h.a  phyriology  i.  o«ltiv.t,d  «  »  -ri^^u! 

Lm  the  labo^tory.    On  the  otto  hand,  *«  «»« 
Zutie.  lot  work  are  now  mo«  num«ou.,  and  the  tram 

r:t:ch°  a  .onn«  <t-rh"p'to'"--^ 

Z^ZmcX  t«ining  and  a  complete  eqmpmen 
thotougn  0  ^^1,  ,„  i«,  often  met 

::ir*^  IXr^cian  th.n  a  good  practi.^  know 
Z.  .1  morbid  anatomy,  and,  if  oar  P««peet.ve    c  . 
l^rhas  to  limit  hi.  work,  chemietry  and  phy^ioL^y 
AM  yidd  to  the  claims  of  the  dead-hoow.    In  ..» 
ttU tried  he  Bhould  see  autopsies  daUy.  .f  po«.ble. 
S^  taowledge  of  the  infhuU  variations  of  disuse 
^7  be  obtained  by  a  prolonged  study  of  morbid 
Z^l    W^rof  specW  value  in  training  the  phys.c»n 
anatomy,    "m-        ^  ^  y,  ^^kes, 

L^r«lt::^ns  aright,  it  may  serve  to  keep 

"^lit'of  course,  a  very  fuU  propamme,  but  in  ^n 
u  •  i,f  man  With  what  Sydenham  caUs  the 
="•"„:  a^trir'dil^nce  of  Hippocrate'."  »"'  ^f 
r:^;  toedncation!  and  wiU  b.  fit  to  pass  from  the 
up  a  very  v,  ^^^       ^^^^^  aftej 

dispen^ry  to  the  war^-  ^  ^,^  ^^„,y_ 

re^nv  working  quietly  at  one  of  the  smaller  pl«=es. 
'rn!Z^ye«*bL  spend  three  months  or  longer  m 
^*  Xn  schemes  are  laid  in  advance  it  .  sjnpnsmg 
^roften  the  circumstances  fit  m  w,th  them.    How  shaU 

144 


INTERNAL   MEDICINE   AS   A   VOCATION 

he  live  meanwhile  ?  On  crumbs— on  pickings  obtained 
from  men  in  the  cakes-and-ale  stage  (who  alwa}r8  can 
put  paying  work  into  the  hands  of  young  men),  and  on 
fees  from  classes,  journal  work,  private  instruction,  and 
from  work  in  the  schools.  Any  sort  of  medical  practice 
should  be  taken,  out  with  caution — too  much  of  it  early 
may  prove  a  good  man's  ruin.  He  cannot  expect  to  do 
more  than  just  eke  out  a  living.  He  must  put  his  emotions 
on  ice ;  there  must  be  no  "  Amaryllis  in  the  shade,"  and 
he  must  beware  the  tangles  of  "  Neaera's  hair."  Success 
during  the  first  ten  years  means  endurance  and  perse- 
verance ;  all  things  come  to  him  who  has  learned  to  labour 
and  wait,  who  bides  his  time  "ohne  Hast,  aber  ohne  Rast," 
whose  *alent  develops  "  in  der  Stille,"  in  the  quiet  fruitful 
years  of  unselfish  devoted  work.  A  few  words  in  addition 
about  this  dry-bread  decade.  He  should  stick  closely 
to  the  dispensaries.  A  first-class  reputation  may  be 
built  up  in  them.  Byrom  Bram well's  Atlas  of  Medicine 
largely  represents  his  work  while  an  assistant  physician 
to  the  Royal  Infirmary,  Edinburgh.  Many  of  the  best- 
known  men  in  London  serve  ten,  fifteen,  or  even  twenty 
years  in  the  out-patient  departments  before  getting  wards. 
Lauder  Brunton  only  obtained  his  full  physicianship  at 
St.  Bartholomew's  after  a  service  of  more  than  twenty 
years  in  the  out-patient  department.  During  this  period 
let  him  not  lose  the  substance  of  ultimate  success  in  grasp- 
ing at  the  shadow  of  present  opportunity.  Time  is  now 
his  money,  and  he  must  not  barter  away  too  much  of  it 
in  profitless  work — profitless  so  far  as  his  education  is 
concerned,  though  it  may  mean  ready  cash.  Too  many 
"  quiz "  classes  or  too  much  joiurnal  work  has  ruined 
AE.  145  h 


WTERNiLL  MK,-.i.l.NK    Vs   A   VOCATION 

Bowan  «l«nce  of  near  v  mv,  ,    .ear.,  whioh  the  great 
d  followed  (and  broke  .   »..rst  mto  a  fuU*- 
repaUtion)   oamrot  bo   enioined,   the   W   P^!^'"»"^ 
id  be  c^elu.  -hac  and  ho.  he  «r,te..    Let  h,m  «1^ 
heed  to  his  education,  «.d  hi.  reputation  wJl  take  care 
ontsdf    and  in  a  development  under  the  guidance  of 
1   ™  betu  find  vienty  of  material  for  paper.  Wore 
Sieal  »cietie.  and  for  publication  in  «.entJic  joumU  _ 
I  would  like  to  add  here  a  few  word,  on  the  ,ue.t,on  of 

diL^  instruction,  a.  with  the  6«"  P-P-""! '"^^T- 
out  in  our  KhooU  there  will  be  many  chance,  of  employ 
ment "ryoung  phyrician.  who  wi.h  to  follow  medione 
rl  »  .^3on.    To-day  thi.  .eriou.pn.Mcm  con^ 
K  ^e  profe^or.  in  many  of  o>.  -k""  "^ 
U»ch  practical  medicine  to  the  l«ge  cl.»e,  •,  how  t„  g.ve 
Zl  protracted  and  .y.tematie  ward  .n.truct.on  ?    I 
^.  li  no  teacher  in  the  country  who  control,  eno^ 
eUnical  material  tor  the  instruction  of  ela^.  «y  o.  200 
rr„  during  the  third  and  fourth  year..    It  «em.   ■•  me 
that  there  are  two  plan,  open  to  the  -1>°*  ."J 
I  to  utai«  di.pen.arie,  for  clinical  m..ruct,on  much 
1^  than  i.  at  pre^nt  the  rule.    For  ■.,„  purpo.c  a 
Chil^room  for  'a  c!  ..  of  twenty-ave  or  '^^^^ 
immediately  adjoining  the  di.pen.ary  ..  e.«;nt>al.    For 
r^L'n  pLy.lc^  aiagno.i.,  for  the  obicet.^  trac- 
ing of  diMa.e,  and  for    he  in.truct,on  of  .tudent.  .n  the 
Z  of  their  sen..,  .uch  an  arrangement  ..  .nv^u^ble^ 
There  are  hundred,  of  di.pcn.ane.  m    '"■*     ^^      ;. 
U  fea.ible,  and  in  which  the  matenal  no.  >s  not  pro     rl,^ 
•orkcd  up  beoauM  of  the  lack  oi  this  vs;;   5..un.!.tt.. 

146 


i 
1 
I 


INTERNAL  MEDICTNF    A.<   A    VOCATION 

the  second  place.  I  feel  sure  tha+  ultima ♦'ly  we  shall  d*"- 
velop  a  system  •  f  extra-mural  'oachin  similar  t^o  that 
which  has  been  ^o  successful  Ed.  urgh ;  md  thi« 
will  give  employment  to  n  large  number  of  thi  'ounger 
men.  M  any  large  university  si  ■  ool  of  medicii  ^  there 
might  be  four  or  *ive  extra-mural  teachers  of  medicine, 
selected  from  men  who  could  show  that  they  were  fully 
qualified  to  teach  and  that  they  had  a  sufficient  number  of 
beds  at  their  commarid  with  proper  equipment  for  clinical 
work.  At  Rdinbursh  there  are  eight  extra-mura  teachers 
of  internal  medicine  whose  courses  jualify  the  studen*  to 
present  himself  for  examination  either  before  the  R*  val 
Colleges  or  the  University.  If  we  e  er  are  to  give  amr 
third  and  fourth  year  studei  i  pro'^ -acted  and  comple' 
courses  in  physical  diagnosis  and  clinical  nx  dicin>  ax- 
tendinc  throughout  the  session,  and  not  in  cL^asep  >i  a 
brief  period  of  six  v^ceks'  dnjation,  I  am  con;  ler  ths^ 
the  number  of  men  engaged  in  teaching  must  greatly 
increased. 

IT 

Ten  years'  *  ard  -^ork  tells  with  colleagut    an     fn^r-is 
in  the  professi'       and  with  <"nlarged  clinical  ae 

].hy8ician  ent<  rs  upon  the      cond,  or  bre  -butter 

period.  This,  o  most  m*»n,  is  the  jn-eat  tnai  51  e  the 
risks  are  greater,  and  many  uow  (iro[.  out  of  th*  race, 
wearied  at  the  length  of  the  way  and  drift  into  specialism 
or  general  practice.  The  physician  develops  more  slowly 
than  the  surgeor-  and  success  comes  later  There  are 
surgeons  at  forty  year  in  full  practice  auu  it  the  very 
top  of  the  wave,  a  ti:   3  at  which  the  phj^ician  is  only 

147 


INTERNAL  MBDICTNE  AS  A  VOCATION 
„«™ring  to  reap  the  harvest  of  year,  ol  patient  tod 
Thfrton  mJ  have  hancU,  and  better,  young  hands. 
He  , Shave  a  head,  too,  hut  this  doe.  not  e«m  « 
fln«  to  .ueoe«,  and  he  cannot  have  an  old  head  wrth 
vtlhanda.  At  the  end  oltwenty  years,  when  about  orty 
Cour  Lydgateshould  have  a  first-class reputahon  m  the 
pXon.'a^d  a  large  circle  o.  friends  and  s^e^-    He 
L  „fobably  have  precious  little  capital  m  the  bank,  but 
T.^Tl  accuiuation  of  inter.st.be«ing  funds  «. 
his  tain.pfn.    He  has  gathered  a  stock  of  "P^-l  ^■'°- 
lie  which  his  friends  in  the  profession  apprec-ate,  and 
ty  begin  to  seek  his  counsel    -  doubtfal  case,    and 
griually  learn  to  lean  upon  hm  »  "»»  °' '"^  ^ 
may  awake  some  day.  perhaps,  quite  suddenly,  to  tod 
It  twenty  years  of  quiet  work,  done  for  the  love  of  it, 
has  a  very  solid  value  ^^^  ^  ^^^ 

The  environment  of  a  large  ciiy  w  "" 
Jwth  of  a  good  clinical  physician.    Even  m  small  towns 
iTln  can    if  he  has  it  in  him,  become  weU  versed  m 
len  o"  work,  and  with  the  assistance  of  an  o^™« 
visit  to  some  medical  centre  he  can  become  an  expert 

H6«l  Dieu,  ha.  just  gone.    He  wroU  askmg  me  for 

148 


INTERNAL  MEDICINE   AS   A  VOCAT      ^ 

letter  of  advice,  from  which  I  take  the  liberty  of  extract- 
ing one  or  two  paragraphs : — 

"Your  training  warrants  a  high  aim.    To  those  who 
ask,  say  that  you  intend  to  practise  medicine  only,  and 
will  not  take  surgical  or  midwifery  cases.    X.  has  promised 
that  you  may  help  in  the  dispensary,  ana  as  you  can 
count  blood  and  percuss  a  cheat  you  will  be  useful  to  him 
in  the  wards,  which,  by  the  way,  he  now  rarely  visits. 
Be  careful  with  the  house  physicians,  and  if  you  teach 
them  anything  do  it  gently,  and  never  crow  when  you 
are  right.    The  crow  of  the  young  rooster  before  his  spurs 
are  on  always  jars  and  antagonizes.    Get  your  own  little 
clinical  laboratory  in  order.    Old  Dr.  Rolando  will  be 
sure  to  visit  you,  and  bear  with  him  as  he  tells  you  how 
he  can  tell  casts  from  the  ascending  limb  of  the  loop  of 
Henle.    Once  he  was  as  you  are  now,  a  modern,  twenty 
years  ago ;  but  he  crawled  up  the  bank,  and  the  stream 
has  left  him  there,  Ijut  he  does  not  know  it.     He  means 
to  impress  you  ;  be  civil  and  show  him  the  new  Nissl- 
stain  preparations,  and  you  will  have  him  as  a  warm 
friend.    His  good  heart  has  kept  him  with  a  large  general 
practice,  and  he  can  put  post-mortetns  in  your  way,  and 
may  send  for  you  to  sit  up  o'  nights  with  his  rich  patients. 
If  Y.  asks  you  to  help  in  the  teaching,  jump  at  the  chance. 
The  school  is  not  what  you  might  wish,  but  the  men  are 
in  earnest,  and  a  clinical  microscopy-class  or  a  voluntary 
ward-class,  with  Y.'s  cases,  will  put  you  on  the  first  rung 
of  the  ladder.    Yes,  join  both  the  city  and  the  county 
society,  and  never  miss  a  meeting.    Keep  your  mouth 
shut  too,  for  a  few  years,  paHicularly  in  discussions. 
Let  the  old  men  read  new  books ;  you  read  the  journals 

149 


INTERNAL  BIEDTCINE  AS  A  VOCATION 
and  the  old  books.    Study  LaSrmec  this  winter ;  ForWa 
Translation  can  be  cheaply  obtained,  but  it  wiU  help  to 
keep  up  your  French  to  read  it  in  the  original.    The  old 
Sydenham  Society  editions  of  the  Greek  writers  and  of 
Sydenham  are  easUy  got  and  are  reaUy  very  helpful.    Aa 
a  teacher  you  can  never  get  orieniirt  without  a  knowledge 
of  the  Fathers,  ancient  and  modem.    And  do  not  forget, 
above  aU  things,  the  famous  advice  to  Blackmore,  to  whom, 
when  he  first  began  the  study  of  physic,  and  asked  what 
books  he  should  reul,  Sydenham  replied,  Don  QutxoU 
meaning  thereby,  as   I   take  it.  that  the  only  book  o 
physic  suitable   for   permanent   reading   is  the  book   ol 

Nature." 

A  young  fellow  with  staying  powers  who  avoids  entangle- 
ments, may  look  forward  in  twenty  yearn  to  a  good  con- 
sultation practice  in  any  town  of  40.000  to  50,000  m- 
habitants.  Some  such  man.  perhaps,  in  a  town  far  distant, 
taking  care  of  his  education,  and  not  of  his  bank  book, 
may  be  .he  Austin  Flint  of  New  York  in  1930. 

"  Many  are  called,  but  few  are  chosen,"  and  of  the  many 
who  start  out  with  high  aims,  few  see  tha  goal.    Even 
when  reached  the  final  period  of  "  cakes  and  ale  "  has 
serious  drawbacks.    There  are  two  groups  of  consultants, 
the  intra-  and  the  extra-professional ;  the  one  gets  work 
through  his  colleagues,  the  other,  having  outgrown  the 
narrow  limits  of  professional  reputation,  is  at  the  mercy 
of  the  profanum  vul^us.    Then  for  him  "  farewell  the 
tranquil  mind,  fareweU  content."    His  life  becomes  an 
incessant  struggle,  and  between  the  attempt  to  carry  on 
an  exhausting  and  irksome  practice,  and  to  keep  abreast 
with  young  fellows  still  in  the  bread-and-butter  stage, 

150 


■MiMiili 


X 

'■ 
i 


'^i 


INTERNAL  MEDICINE   AS   A  VOCATION 

the  consultant  at  this  period  is  worthy  of  our  sincerest 
sympathy. 

One  thing  may  save  him.  It  was  the  wish  of  Walter 
Savage  Landor  always  to  walk  with  Epicurus  on  the  right 
hand  and  Epictetus  on  the  left,  and  I  would  urge  the 
clinical  physician,  as  he  traveb  farther  from  the  East,  to 
look  well  to  his  companions— to  see  that  they  are  not  of 
his  own  age  and  generation.  He  must  walk  with  the 
"  boys,"  else  he  is  lost,  irrevocably  lost ;  not  all  at  once, 
but  by  easy  grades,  and  every  one  perceives  his  ruin  before 
he,  "  good,  easy  man,"  is  aware  of  it.  I  would  not  have 
hint  a  basil  plant,  to  feed  on  the  brains  of  the  bright  young 
fellows  who  follow  the  great  wheel  uphill,  but  to  keep 
his  mind  receptive,  plastic,  and  impressionable  he  must 
travel  with  the  men  who  are  doing  the  work  of  the  world, 
the  men  between  the  ages  of  twenty-five  and  forty. 

In  the  life  of  every  successful  physician  there  comes 
the  temptation  to  toy  with  the  Delilah  of  the  press— daily 
and  otherwise.    There  are  times  when  she  may  be  courted 
with  satisfaction,  but  beware !  sooner  or  later  she  La  sure 
to  play  the  harlot,  and  has  left  many  a  man  shorn  of  his 
strength,  viz.,  the  confidence  oi  his  professional  brethren. 
Not  altogether  with  justice  have  some  notable  members 
of  our  profession  laboured  under  the  accusation  of  pan- 
dering too  much  to  the  public.    When  a  man  reaches  the 
climacteric,  and  has  long  passed  beyond  the  professional 
stage  of  his  reputation,  we  who  are  still  "  in  the  ring  " 
must  exercise  a  good  deal  of  charity,  and  discount  largely 
the  on  dits  which  indiscreet  friends  circulate.     It  cannot 
be  denied  that  in  dealings  with  the  public  just  a  little 
touch  of  humbug  is  immensely  effective,  but  it  is  not 

151 


INTERNAL  MEDICINE  AS  A  VOCATION 
aecc«»ry.  In  a  large  city  there  were  three  eminent 
consultants  of  world-wide  reputation;  one  was  said  to 
be  a  good  physician  but  no  humbug,  the  second  was  no 
physician  but  a  great  humbug,  the  third  was  a  great 
physician  and  a  great  humbug.  The  first  achieved  the 
greatest   success,    professional   and   social,    possibly   not 

financial. 

While  living  laborious  days,  happy  in  his  work,  happy 
in  the  growing  recognition  which  he  is  receiving  from  his 
coUeagues,  no  shadow  of  doubt  haunts  the  mind  of  the 
young  phvsician,  other  than  the  fear  of  failure  ;  but  I  warn 
him  to  cherish  the  days  of  his  freedom,  the  days  when  he 
can  follow  his  bent,  untrammeled,  undisturbed,  and  not 
as  yet  in  the  coils  of  the  octopus.    In  a  play  of  Oscar 
Wilde's  one  of  the  characters  remarks,  "  there  are  only 
two  great  tragedies  in  life,  not  getting  what  you  want- 
and  getting  it !  "  and  I  have  known  consultants  vihose 
treadmill  life  illustrated  the  bitterness  of  this  mot,  and 
whose  great  success  at  sixty  did  not  bring  the  comfort 
they  had  anticipated  at  forty.    The  mournful  echo  of 
the  words  of  the  preacher  rings  in  their  ears,  words  which 
I  not  long  ago  heard  quoted  with  deep  feeling  by  a  dis- 
tinguished physician,  "  Better  is  an  handful  with  quietness, 
than  both  the  hands  full  Nvith  travail  and  vexation  of 
spirit." 


\ 


162 


IX 


'I 

I 


NURSE  AND  PATIENT 


iw 


i 


l«ud.IwiUtakeheedtomywayB.    that  I  offend  not  in  my 
^nJSi  keep  my  mouth  a8  it  were  with  a  bridle^^  ^^  ^^  ^ 

If  thou  hast  heard  a  word,  let  it  die  with  thee ;  and  be  bold. 
it  wiU  not  burst  thee.  ecclksusticxts  xix.  10. 

Lo,  in  the  vale  of  years  beneath 

A  grisly  troop  are  seen. 

The  painful  family  of  death. 

More  hideous  than  their  queen : 

This  racks  the  joints,  this  fires  the  vems. 

That  every  labouring  sinew  strains. 

Those  in  the  deeper  vitala  rage  :  ^^^^^  ^^^^ 


H   .1 


154 


IX 


If 


NURSE  AND  PATIENT  ' 

THE  trained  nurse  as  a  factor  in  life  may  be  regarded 
from  many  points  of  view— philanthropic,  social, 
personal,  professional  and  domestic.    To  her  virtues  we 
have  been  exceeding  kind— tongues  have  dropped  manna 
in  their  description.    To  her  faults— well  let  us  be  blind, 
since  this  is  neither  the  place  nor  the  time  to  expose  them. 
I  would  rather  call  your  attention  to  a  few   problems 
connected  with  her  of  interest  to  us  collectively,— and 
individually,  too,  since  who  can  tell  the  day  of  her  coming. 
la  she  an  added  blessing  or  an  added  horror  in  our  be- 
ginning civilization?    Speaking  from  the  point  of  view 
of  a  sick  man,  I  take  my  stand  firmly  on  the  latter  view, 
for  several  reasons.    No  man  with  any  self-respect  cares 
to  be  taken  off  guard,  in  mufti,  so  to  speak.    Sickness 
dims  the  eye,  pales  the  cheek,  roughens  the  chin,  and  makes 
a  man  a  scarecrow,  not  fit  to  be  seen  by  his  wife,  to  say 
nothing  of  a  strange  woman  all  in  white  or  blue  or  gray. 
Moreover  she  will  take  such  unwarrantable  liberties  with 
a  fellow,  particularly  if  she  catches  him  with  fever ;  then  her 
special  virtues  could  be  depicted  by  King  Lemuel  alone. 
So  far  as  she  is  concerned  you  are  again  in  swathing  bands, 

>  Johns  Hopkins  Hospital,  1897. 
165 


NURSE  AND  PATIENT 

and  in  her  hands  you  are,  as  of  yore,  a  helpless  lump  of 
human  clay.    She  will  stop  at  nothing,  and  between  baths 
and  spongings  and  feeding  and  temperature-taking  you 
are  ready  to  cry  with  Job  the  cry  of  every  sick  man — 
"  Cease  then,  and  let  me  alone."    For  generations  has  not 
this  been  his  immemorial  pri^nlege,  a  privilege  with  vested 
rights  as  a  deep-seated  animal  instinct — to  turn  his  face 
toward  the  wall,  to  sicken  in  peace,  and,  if  he  so  wishes, 
to  die  undisturbed  ?    All  this  the  trained  nurse  has,  alas ! 
made  impossible.    And  more,  too.    The  tender  mother, 
the  loving  wife,  the  devoted  sister,  the  faithful  friend,  and 
the  old  servant  who  ministered  to  his  wants  and  carried 
out  the  doctor's  instructions  so  far  as  were  consistent 
with  the  sick  man's  wishes— all,  all  are  gone,  these  old 
familiar  faces ;  and  now  you  reign  supreme,  and  have 
added  to  every  illness  a  domestic  complica^^icn  of  which 
our    fathers    knew    nothing.      You   have  upturned   an 
inalienable  right  in  displacing  those  whom  I  have  just 
mentioned.    You  are  intruders,  innovators,  and  usurpers, 
dislocating,  as  you  do,  frcn  theur  tcnderest  and  most  loving 
duties  these  mothers,  wives  and  sisters.    Seriously,  you 
but  lightly  reck  the  pangs  which  your  advent  may  cause. 
The  handing  over  to  a  stranger  the  care  of  a  life  precious 
beyond  all  computation  may  be  one  of  the  greatest  earthly 
trials.    Not  a  little  of  all  that  is  most  sacred  is  sacrificed 
to  your  greater  skill  and  methodical  ways.    In  the  com- 
plicated fabric  of  modern  society  both  our  nursing  and 
our  charity  appear  to  be  better  done  second-hand,  though 
at  the  cost  in  the  one  case  as  in  the  other  of  many  Beatitudes, 
links  of  that  golden  chain,  of  which  the  poet  sings,  let 

down  from  heaven  to  earth. 

15G 


H 


NURSE   AND   PATIENT 
Except  in  the  warped  judgment  of  the  sick  man,  for 
which  I  have  the  wannest  sympathy,  but  no  respect, 
you  are  regarded  as  an  added  blessing,  with,  of  course, 
certain  limitatioi.^.    Certainly  you  have  made  the  practice 
of  medicine  easier  to  the  physician ;  you  arc  more  than 
the  equivalent  of  the  old  two  hourly  doses  to    a    fever 
patient ;  and  as  the  public  grows  in  intelligence  you  should 
save  in  many  instances  the  entire  apothecary's  bill.    In 
his  chapter  on  Instinct,  in  the  Origin  of  the  Species,  Dar- 
win gives  a  graphic  account  of  the  marvellous  care-takmg 
capacity  of  the  little  Formica  fusca-a  slave  ant.    One 
of  these  "  introduced  into  a  company  of  her  masters  who 
were  helpless  and  actually  dying  for  lack  of  assistance, 
instantly  set  to  work,  fed  and  saved  the  survivors,  made 
some  cells,  and  tended  the  larvae  and  put  all  to  rights. 
Vta  aU  to  riqUs  !    How  often  have  I  thought  of  this  ex- 
pression and  of  this  incident  when  at  your  word  I  have 
seen  order  and  quiet  replace  chaos  and  confusion,  not  alone 
in  the  sick-room,  but  in  the  household. 

As  a  rule,  a  messenger  of  joy  and  happiness,  the  trained 
nurse  may  become  an  incarnate  tragedy.  A  protracted 
illness,  an  attractive  and  weak  Mrs.  Ebb-Smith  as  nurse, 
and  a  weak  husband— and  all  husbands  are  weak— make 
fit  elements  for  a  domestic  tragedy  which  would  be  far 
more  common  were  your  principles  less  fixed. 

WhUe  thus  a  source  of  real  terror  to  a  wife,  you  may 
become  a  more  enduring  misery  to  a  husband.  In  our 
huni.-d  progress  the  weak-nerved  sisters  have  suffered 
surely,  and  that  deep  mysterious  undercurrent  of  the 
emotions,  which  flows  along  silently  in  each  one  of  us,  is 
apt  to  break  out  in  the  rapids,  eddies  and  whirls  of  hysteria 

157 


K- 


NURSE   AND  PATIENT 
or  neurasthema.    By  •  finely  measured  sympathy  and 
.  wiw  combination  of  affection  with  firmness,  you  gam  the 
fuU  confidence  of  one  of  these  unfortunates,  and  b«rome 
to  her  a  rock  of  defence,  to  which  she  clings,  and  without 
which  she  feels  again  adrift.    You  become  e«^ntml  m  her 
life,  a  fixture  in  the  family,  and  at  times  a  dark  shadow 
between  husband  and  wife.    As  one  poor  victun  expressed 
it.  "  She  owns  my  wife  body  and  soul,  and.  so  far  as  I  am 
concerned,  she  has  become  the  equivalent  of  her  disease. 
Sometimes  there  develops  that  occult  attraction  between 
women,  only  to  be  explamed  by  the  theory  of  Aristophanes 
as  to  the  origin  of  the  race ;  but  usuaUy  it  grows  out  of 
the  natural  leaning  of  the  weak  upon  the  strong,  and  m 
the  nurse  the  wife  may  find  that  "  stern  strength  and  pro- 
mise of  control "  for  which  in  the  husband  she  looked  m 

vain.  ,  ., 

To  measure  finely  and  nicely  your  sympathy  m  these 
cases  is  a  very  deUcate  operation.    The  individual  tempera- 
ment controls  the  situation,  and  the  more  mobile  of  you 
wiU  have  a  hard  lesson  to  learn  in  subduing  your  emotions. 
It  is  essci  tial,  however,  and  never  let  your  outward  action 
demonstrate  the  native  act  and  figure  of  your  heart.    You 
are  lost  irrevocably,  should  you  so  far  give  the  rems  to 
your  feelings  as  to  "  ope  the  sacred  source  of  sympathetic 
tears "    Do  enter  upon   your  duties  with  a    becoming 
sense  of  your  frailties.    Women  can  fool  men  always, 
women  only  sometimes,  and  it  may  be  the  lot  of  any  one 
of  you  to  be  such  a  castaway  as  the  nurse  of  whom  I  was 
told  a  few  weeks  ago.    The  patient  was  one  of  those 
Alphonsine  Plessis-'Ae  creatures   whom    everybody  had 
to  love,  and  for  whom  the  primrose  path  of  dalliance  had 

168 


NURSE  AND   PATIENT 

ended  in  a  rigid  rett  cure.  After  three  weary  months  she 
was  sent  to  a  quiet  place  in  the  mountains  with  the  more 
sedate  of  the  two  nurses  who  had  been  with  her.  ^Lm 
Blank  had  had  a  good  training  and  a  large  experience, 
and  was  a  New  England  urom&n  of  the  very  best  type. 
Alas !  hers  the  greater  fall !  An  accomplishment  of  this 
siren,  which  had  produced  serious  symptoms,  was  excessive 

cigarette  smoking,  and  Dr.  had  strictly  forbidden 

tobacco.  Three  weeks  later,  my  informant  paid  a  visit 
to  the  secluded  resort,  and  to  his  dismay  found  patient 
and  nurse  on  the  verandah  enjoying  the  choicest  brand  of 
Egyptian  cigarette ! 

While  not  the  recipient  of  all  the  wretched  secrets  of  life, 
as  are  the  parson  and  the  doctor,  you  will  frequently  be 
in  households  the  miseries  of  which  cannot  be  hid,  all 
the  cupboards  of  whicj  are  open  to  you,  and  you  become 
the  involuntary  possessor  of  'he  most  sacred  confidences, 
known  perhaps  to  no  other  soul.  Nowadays  that  part  of 
the  Hippocratic  oath  which  enjoins  secrecy  as  to  the  things 
seen  and  heard  among  the  sick,  should  be  administered  to 
you  at  graduation. 

Printed  in  your  remembrance,  written  as  headlines  on 
the  tablets  of  your  chatelames,  I  would  have  two  maxims  : 
"  I  will  keep  my  mouth  as  it  were  with  a  bridle,"  and  "  If 
thou  hast  heard  a  word  let  it  die  with  thee."  Taciturnity, 
a  discreet  silence,  is  a  virtue  little  cultivated  in  these  garru- 
lous days  when  the  chatter  of  the  bander-log  is  every- 
where about  us,  when,  as  some  one  has  remarked,  speech 
has  taken  the  place  of  thought.  As  an  inherited  trait  it 
is  perhaps  an  infirmity,  but  the  kind  to  which  I  refer  is 
an    acquired    faculty  of    infinite    value.      Sir    Thomas 

159 


i 


ii 


( 


if 

4 
m  N 


NDE8E  AND  PATIENT 

b™-„.  d«w  th.  dutinction  nicly  when  kt^  "i*.  "  '^^"^ 

T^^ZTt^  ™dom  ol  looU,  but,  ii  rightly  ..m«J, 

:::^rJ.:rten,  Who  have  not  the  «b„t 

the  virtue  of  taeitumity."-th.  talent  for  «lence  Crlyl. 

"Itog.  medical  .nd  grue^me  have  a  ,ingul,.r  attraction 
lor  rn^fy  people,  and  in  the  oy  day.  °'  -"— i; 
boUe-tongued  nur«  may  be  W  on  to  tell  of  movrng 
•     J    ,."   in  ward  or  theatre,  and  once   untied,   that 

Ta™  Jn  o!  event..    To  Ulk  of  di«.«.  U  a  «.rt  of  Arab^n 
Ni^f  entertainment  to  which  no  d.»r.et  nur«  v,^, 

Ipnd  her  talents.  . 

Wil  the  growth  of  one  abominabk  pracfce  m  recent 
dl  I  am  nTt  certain  you  have  anything  to  do,  thou  h 
I  Le  heard  your  name  mentioned  i"."-""-™'"*  't 
I  refer  to  the  habit  of  openly  di«u»mg  adment.  which 

h^u^  never  be  mentioned.  Doubtle..  it  Una  mea.ure 
t  reedt  of  the  di.gu.ting  publicity  in  wbch  we  l.ve, 
andrthepemiciouehabHofaUowingthefilthoftheguter. 

,  a.  preyed  in  the  newpaper.  to  pollute  the  stream  of  our 
^y  live..    ThUopen  talk  about  per«>m>l  mdadje.  u  an 
^i„„.  breach  of  good  manner..    Not  a  month  ago,  I 
h~o  women,  both  taUor-made,  who  .at  oppo..te  ^ 
mTin  a  .treet-car,  compare  note,   on   '  »   —« 
in  Fulvian  accent,  audible  to  everyone.    I  have  heard  a 
"ung  woman  at  a  dinner-table  relate  expenencc.  which 
ler  Ither  would  have  bluebcd  to  have  told  to  the  fanuly 
plyli^..    Everything  nowaday,  i.  proclaimed  from  the 
t^!top.,  among  them  our  Uttle  bodily  woe.  and  worr,«. 
Z  i.  a^  lap«  from  the  go»J  old  pracfce  ol  our  grand- 

160 


NURSE    AND   PATIENT 

ffttken,  of  which  Oco^e  Sand  write*,  "  People  knew  how 
to  live  and  die  in  thoae  days,  and  k^'pt  their  iixfinnitiea 
out  of  sight.  You  might  have  the  goitt,  but  you  mu«t 
walk  about  all  the  same  without  making  grimace?  It 
was  a  point  of  good  breeding  to  hido  one  sufiermg." 
We  doctors  are  great  sinners  in  this  manner,  and  among 
ourselves  and  with  the  laity  are  much  too  fond  oi  "  Ulkuig 

shop." 

To  anotuer  danger  I  may  refer,  now  that  I  have  waxed 
bold.  With  the  fullest  kind  of  training  you  cannot  escape 
from  the  perib  of  half-knowledge,  of  pseu.io  science,  that 
most  fatal  and  common  of  mental  states.  In  your  daily 
work  you  involuntarily  catch  the  accents  and  learn  the 
language  of  science,  often  without  a  clear  conception 
of  its  meaning.  I  turned  mcidentally  one  day  to  a  very 
fine  example  of  the  nurse  learned  and  asked  in  a  humble 
tone  what  the  surgeon,  whom  I  had  failed  to  meet, 
had  thought  of  the  case,  and  she  promptly  replied  that 
"  he  thought  there  were  features  suggestive  of  an  intra- 
canalicular  myxoma ; "  and  when  I  looked  anxious  and 
queried,  "  had  she  happened  to  hear  if  he  thought  it  had 
an  epiblastic  or  mesoblastic  origin  ?  "  this  daughter  of 
Eve  never  flinched  ;  "  mesoblastic,  I  believe,"  was  her 
answer.  She  would  have  handed  sponges— I  mean  gauze — 
with  the  same  sang  froid  at  a  Waterloo 

It  must  be  very  difficult  to  ie.iit  the  fascination  of  a 
desire  to  know  more,  much  more,  of  the  deeper  depths  of 
the  things  you  see  and  hear,  and  often  this  ignorance  must 
be  very  tantalizing,  but  it  is  more  wholesome  than  an 
assurance  which  rests  on  t  thin  veneer  of  knowledge. 

A  friend,  a  distinguished  surgeon,  has  written,  in  the 

AS.  161  M 


NURSE   AND   PATIENT 

Lady  Priestley  vein,  an  essay  on  "  The  Fall  of  the  Trained 
Nurse,"  which,  so  far,  he  has  very  wisely  refrained  from 
publishing,  but  he  has  permitted  me  to  make  one  extract 
for  your  delectation.  "  A  fifth  common  decleniion  is  into 
the  bonds  of  marriage.    The  facility  with  which  these 
modem  Vestals  fall  into  this  commonplace  condition  is  a 
commentary,  shall  I  not  say  rather  an  illustration,  of  the 
inconsistency  so  notorious  in  the  sex.    The  Association  of 
Superintendents  has  in  hand,  I  believe,  a  Collective  Inves- 
tigation dealing  with  this  question,  and  we  shall  shortly 
have  accurate  figures  as  to  the  percentage  of  lady  super- 
intendents, of  head-nurses,  of  graduates  and  of  pupils 
who  have  bartered  away  their  heritage  for  a  hoop  of  gold." 
I  am  almost  ashamed  to  quote  this  rude  paragraph, 
but  I  am  glad  to  do  so  to  be  able  to  enter  a  warm  protest 
against  such  sentiments.    Marriage  is  the  natural  end  of 
the  trained  nurse.    So  truly  as  a  young  man  married 
is  a  young  man  rcarred,  is  a  woman  unmarried,  in  a  certam 
sense,   a  woman  undone.     Ideals,  a    career,    ambition, 
touched  though  they  be  with  the  zeal  of  St.  Theresa, 
all  vanish  before  "  the  blind  bow-boy's  butt  shaft."     Arc 
you  to  be  blamed  and  scoffed  at  for  so  doing  ?    Contrari- 
wist',  you  are  to  be  praised,  with  but  this  caution— which 
I  insert  a*  the  special  request  of  Miss  Nutting— that  you 
abstain  from  piiilandering  during  your  period  of  training, 
and,  as  much  as  in  you  lies,  spare  your  fellow-workers, 
the  physicians  and  surgeons  of  the  staff.    The  trained  nurse 
is  a  modern  representative,  not  of  the  Roman  Vestal, 
but  of  the  female  guardian  in  Pluto's  republic— a  choice 
selection  fiom  the  very  best  women  of  the  community, 
who  know  the  laws  of  health,  and  whose  sympathies  have 

1G2 


n 


NURSE  AND  PATIENT 


3 


been  deepened  by  contact  with  tue  best  and  worst  of  men. 
The  experiences  of  hospital  and  private  work,  while  they 
may  not  make  her  a  Martha,  enhance  her  value  in  many 
way?  as  a  life-companion,  and  it  is  a  cause,  not  for  re- 
proach, but  for  congratulation,  that  she  has  not  acquired 
immunity  from  that  most  ancient  of  all  diseases — that 
malady  of  which  the  Rose  of  Sharon  sang  so  plaintively, 
that  sickness  '*  to  be  stayed  not  with  flagons  nor  comforted 
.rith  apples." 

A  luxury,  let  us  say,  in  her  private  capacity,  in  public 
the  trained  nurse  has  become  cue  of  the  great  blessings 
of  humanity,  taking  a  place  beside  the  physician  and  the 
priest,  and  not  inferior  to  cither  in  her  mission.  Not  that 
lier  calling  here  is  in  any  way  new.  Time  out  of  mind 
she  lias  made  one  of  a  trinity.  Kindly  lioada  have  always 
been  ready  to  devise  means  for  allaying  suffering ;  tender 
hearts,  surcharged  with  the  miseries  of  this  "  battered 
caravanserai,"  hav<;  ever  been  ready  to  speak  to  the  sufferer 
of  a  way  of  peace,  and  loving  hands  have  ever  ministered 
to  those  in  sorrow,  need  and  sickness.  Nursing  as  an  art 
to  be  cultivated,  as  a  profession  to  be  followed,  is  mcxlern  ; 
nursing  as  a  practice  originated  in  the  dini  past,  when  somo 
mother  among  the  cave-dwellers  cooled  the  forehead  of  her 
sick  child  with  water  from  the  brook,  or  first  yielded  to 
the  prompting  to  leave  a  well-covered  bone  and  a  handful 
of  meal  by  the  side  of  a  wounded  man  left  in  the  hurried 
flight  before  an  enemy.  As  a  profession,  a  vocation, 
nursing  has  already  reached  in  this  country  a  high  develop- 
ment. Graduates  arj  numcro'is,  the  directories  are  full, 
and  in  many  places  there  is  over-crowding,  and  a  serious 
complaint  that  even  very  capable  v.'omen  find  it  hard  to 

103 


I  I  '! 


NURSE  AND  PATIENT 
get  employment.    This  wiU  correct  iteelf  in  time,  m  the 
eziBting  conditions  adjust  the  supply  and  demand. 

A  majority  oi  the  appUcants  to  our  schools  are  women 
who  seek  in  nursmg  a  vocation  in  which  they  can  gam  a 
UveUhood  in  a  womanly  way  ;  but  there  is  another  aspect 
of  the  question  which  may  now  be  seriously  taken  up  m 
this  country.    There  is  a  graduaUy  accumulating  surplus 
of  women  who  will  not  or  who  cannot  fulfil  the  highest 
duties  for  which  Nature  has  designed  them.    I  do  not  know 
at  what  age  one  dare  caU  a  woman  a  spinster.    I  will  put 
it.  perhaps  rashly,  at  twenty-five.    Now.  at  that  cntical 
period  a  woman  who  has  not  to  work  for  her  Uving.  who 
is  without  urgent  domestic  ties,  is  very  apt  to   become 
a  dangerous  element  unless  her  energies  and  emotions 
are  diverted  in  a  proper  channel.    One  skilled  in  hearts 
can  perhaps  read  in  her  face  the  old.  old  story  ;  or  she  caUs 
to  mind  that  tender  verse  of  Sappho— 

Ab  the  sweet-applo  bluBhoe  on  the  end  of  th« 
bough,  the  very  end  of  the  bough,  which  the 
gatherer*  overlooked,  nay  overlooked  not  but  couW 
not  reach. 
But  left  alone,  with  splendid  capacities  for  good,  she 
is  apt  to  fritter  away  a  precious  life  in  an  aimless  round  of 
social  duties,  or  in  spasmodic  efforts  at  Church  work. 
Such  a  woman  needK  a  vocation,  a  calling  which  wiU  satisfy 
her  heart,  and  she  should  be  able  to  find  it  in  nursmg 
without  entering  a  regular  school  or  working  in  ecclesiastical 

harness. 

An  organized  nursing  guUd.  simUar  to  the  German 
Deaconesses,  could  undertake  the  care  of  large  or  small 
institutions,  without  the  establishment  of  training  schooU 

164 


NURSE  AND  PATIENT 

m  the  ordinary  sense  of  the  term.    Such  a  guild  might 
be    entirely  secular,    with    St.  James,    the  Apostle  of 
practical  i-eligion,  as  the  patron.    It  would  be  of  special 
advantage  to  smaller  hospitals,  particularly  to  those  un- 
attacaed  to  Medical  Schoob,  and  it  would  obviate  the 
existmg  anomaly  of  scores  of  training  schools,  in  which 
the  pupils  cannot  get  an  education   in   any  way  com- 
mensurate with  the  importance  of  the  profession.    In 
the  period  of  their  training,  the  members  of  the  Nursing 
Guild  could  be  transferred  from  one  institution  to  another 
until  their  education  was  complete.    Such  an  organization 
would  be  of  inestimable  service  in  connexion  with  District 
Nursing.    The  noble  work  of  Theodore  Fliedner  should 
be  repeated  at  an  early  day  in  this  country.    The  Kaisers- 
werth  Deaconesses  have  shown  the  world  the  way.    I 
doubt  if  we  have  progressed  in  secularism  far  enough 
successfully  to  establish  such  guilds  apart  from  church 
organizations.    The  Religion  of  Humanity  is  thin  stuff 
for  women,  whose  souls  ask  for  somethii^  more  substantial 
upon  which  to  feed. 

There  ia  no  higher  mission  in  this  life  than  nursing  God's 
poor.  In  so  doing  a  woman  may  not  reach  the  ideals  of 
her  soul ;  she  may  fall  far  short  of  the  ideals  of  her  head, 
but  she  will  go  far  to  satiate  those  longings  of  the  heart 
from  which  no  woman  can  escape.  Romola,  the  student, 
helping  her  blind  father,  and  full  of  the  pride  ol  learning. 
we  admire  ;  Romola,  the  devotee,  carrying  in  her  withered 
heart  woman's  heaviest  disappointment,  we  pity  ;  Romola, 
the  nurse,  doing  noble  deeds  amid  the  pestilence,  rescuing 
those  who  were  ready  to  perish,  we  love. 
On  the  stepping-stones  of  our  dead  selvea  we  rise  to 

166 


1 1 


•II 


i  • 


NURSE  AND   PATIENT 

higher  things,  and  in  the  inner  life  the  serene  heights  are 
reached  only  when  we  die  unto  those  selfish  habits  and 
feelings  which  absorb  so  much  of  our  lives.  To  each  one 
of  us  at  some  time,  I  suppose,  has  come  the  blessed  impulse 
to  break  away  from  all  such  ties  and  follow  cherished 
ideals.  Too  often  it  is  but  a  flash  of  youth,  which  darkens 
down  with  the  growing  years.  Though  the  dream  may 
never  be  realized,  the  impulse  will  not  have  been  wholly 
in  vain  if  it  enables  us  to  look  with  sympathy  upon  the 
more  successful  efforts  of  others.  In  Institutions  tlie 
corroding  effect  of  routine  can  be  withstood  only  by  main- 
taining high  ideals  of  work  ;  but  these  become  the  sound- 
ing brass  and  tinkling  cymbals  without  corresponding 
sound  practice.  In  some  of  us  the  ceaseless  panorama 
of  suffering  tends  to  dull  that  fine  edge  of  sympathy  with 
which  we  started.  A  great  corporation  cannot  have  a 
very  fervent  charity  ;  the  very  conditions  of  its  existence 
limit  the  exercise.  Against  this  benumbing  influence, 
we  physicians  and  nurses,  the  immediate  agents  of  the 
Trust,  have  but  one  enduring  corrective — the  practice 
towards  patients  of  the  Golden  Rule  of  Humanity  as 
announced  by  Confucius  :  "  What  you  do  not  like  when 
done  to  yourself,  do  not  do  to  others," — so  familiar  to  us 
in  its  positive  form  as  the  great  Christian  counsel  of  per- 
fection, in  which  alone  are  embraced  both  the  law  and  the 
prophets. 


u 


166 


BRITISH  MEDICINE  IN  GREATER 
BRITAIN 


M 


i  'l 


i     .(' 

i    til 


I    ,    H 


9  I 


107 


'i 


Cranmer.    Nor  shall  this  peace  sleep  with  her;  but  as  when 
The  bird  of  wonder  dies,  the  maiden  phoenix. 
Her  ashes  new-create  another  heir 
As  great  in  admiration  as  herself. 
So  shall  she  leave  her  blessedness  to  one — 
When  heaven  shuU  call  her  from  this  clotid  of 

darkness — 
Who  from  the  sacred  ashes  of  her  honour 
Shall  star-like  rise,  as  great  in  fame  as  she  was. 
And  so  stand  fix'd.    Peace,  plenty,  love,  truth,  terror, 
That  were  the  servants  to  this  chosen  infant, 
Shall  then  be  his,  and  like  a  vine  grow  to  him : 
Wherever  the  bright  sun  of  heaven  shall  shine. 
His  honour  and  the  greatness  of  his  name 
Shall  be,  and  make  new  nations :  he  shall  flourish. 
And,  Uke  a  mountain  cedar,  reach  his  branches 
To  all  the  plains  about  him.    Our  children's  children 
Shall  sec  this,  and  bless  heaven. 

Kiy^g.  Thou  speakest  wonders. 

Shakespeabi,  King  Henry   VIII,  Act  V. 


166 


% 


BRITISH  MEDICINE  IN  GREATER 
BRITAIN  ' 

I 

TO  trace  successfully  the  evolution  of  any  one  of  the 
learned  professions  would  require  the  hand  of  a  master 
— of  one  who,  like  Darwin,  combined  a  capacity  for  patient 
observation  i;vith  philosophic  vision.  In  the  case  of  medi- 
cine the  difficulties  are  enormously  increased  by  the  extra- 
ordinary development  which  has  taken  place  during  the 
nineteenth  century.  The  rate  of  progress  has  been  too 
rapid  for  us  to  appreciate,  and  we  stand  bewildered  and, 
as  it  were,  in  a  state  of  intellectual  giddiness,  when  we 
attempt  to  obtain  a  broad,  comprehensive  view  of  the 
subject.  In  a  safer  "  middle  flight "  I  propose  to  dwell 
on  certain  of  the  factors  which  have  moulded  the  pro- 
fession in  English-speaking  lands  beyond  the  narrow  seas — 
of  British  medicine  in  Greater  Britain  Even  for  this 
lesser  task  (though  my  affiliations  are  wide  and  my  aym- 
pathies  deep)  I  recognize  the  limitations  of  my  fitness,  and 
am  not  unaware  that  in  my  ignorance  I  shall  overlook 
much  which  might  have  rendered  less  sketchy  a  sketch 
necessarily  imperfect. 

Evolution  advances  by  such  slow  and  imperceptible 
degrees  that  to  those  who  are  part  of  it  the  finger  of  time 
scarcely  seems  to  move.    Even  the  great  epochs  are  seldom 

'  British  Medioal  AMOciatloo,  Montreal,  1897. 
169 


'     Jl 


^ 


yii 


^m 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
apparent  to  the  participators.    During  the  last  century 
neither  the  colonists  nor  the  mother  country  appreciated 
the  thrilling  interest  of  the  long-fought  duel  for  the  pos- 
session of  this  continent.    The  acts  and  scenes  of  the  drama, 
to  them  detached,  isolated  and  independent,  now  glide 
like  dissolving  views  into  each  other,  and  in  the  vitascope 
of  history  we  can  see  the  true  sequence  of  events.    That 
we  can  meet  here  to-day,  Britoi..    -n  British  soil,  in  a  French 
province,  is  one  of  the  far-ofi  results  of  that  struggle.    This 
was  bat  a  prelude  to  the  other  great  event  of  the  eighteenth 
century  :  the  revolt  of  tiie  colonies  and  the  founding  of  a 
second  great  English-speaking  iiatK)n— in  the  words  of 
Bishop  Berkeley's  prophecy,  "  Time's  noblest  offspring." 

It  is  surely  a  unique  spectacle  that  a  century  later 
descendants  of  the  actors  of  these  two  great  dramas  should 
meet  in  en  English  city  in  New  France.  Her'',  the  Ameri- 
can may  forget  Yorktown  in  Louisbourg,  the  Englishman 
Bunker  Hill  in  Quebec,  and  the  Frenchman  both  Louis- 
bourg and  Qu.'bec  in  r^hateauguay  ;  wlile  we  Canadians, 
English  and  French,  remembering  former  friendships  and 
forgetting  past  enmities  can  welcome  you  to  our 
country— the  land  in  which  and  for  which  you  have  so 
often  fought. 

Once,  and  only  «»nce,  before  in  tho  history  of  the  worid 
could  such  a  gathering  as  this  hav."  taken  place.  Divided 
though  the  Greeks  were,  a  Hellenic  sentiment  of  extra- 
ordinary strength  united  them  in  certain  assemblies  and 
festivals.  No  great  flight  of  imagination  is  required  to 
picture  a  notable  representation  of  our  profession  in  the 
fifth  century  b.c.  meeting  in  such  a  colonial  town  as  Apri- 
gentum,  under  the  presidency  of  Empedocles.    Delegates 

170 


s 

4 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

from  the  mother  cities,  brilliant  predecessors  of  Hippo- 
crates of  the  stamp  of  Democedes  and  Herodicus,  delegates 
from  the  sister  colonies  of  Syracuse  and  other  Sicilian 
towns,  from  neighbouring  Italy,  from  far  distant  Massilia. 
and  from  still  more  distant  Panticapacum  and  Istria.  And 
in  such  an  assemblage  there  would  have  been  men  capable 
of  discussing  problems  of  life  and  mind  more  brilliantly  than 
in  many  subsequent  periods,  in  proportion  as  the  pre- 
Hippocratic  philosophers  in  things  medical  had  thought 
more  deeply  than  many  of  those  who  came  after  them. 

Wo  Eujilish  aro  the  modern  CJreeks,  and  wo  alone  have 
colonised  as  tlicy  did,  as  free  peoples.     There  have  been 
otlier  great  colcmial  empires,  Phamician,  Roman,  Spanish. 
Dutch  and  French,  but  in  civil  liberty  and  intellectual 
freedom  Matjna  Ora>cia  and  (Jreater  Britain  stand  alone. 
The  parallel  so  often  drawn  between  them  is  of  particular 
interest  with  reference  to  the  similarity  between  the  (treek 
settlements  in   Sicily  and  the  Engli.>;h  plantations  on  the 
Atlantic   coast.     Indeed,    Freeman  says :   "  I  can  never 
think  »>f  America  without  something  suggesting  Sicily,  or 
of  Sicii}  witliout  sonu'tliing  suggesting  America."     I  wish 
to  use  the  jjarallel  only  to  emphasise  two  points,  one  of 
difference   and   one   of   resemblance.     The  Greek  colonist 
took  Greece  with  him.     Hellas  had  no  geograplxical  bounds, 
"  Massilia  and  Olbia  were  cities  of  Hellas  in  as  fiJl  sense 
as  .\thens  or  Sparta."     While  the  emigrant  Britons  changed 
their  sky,  not  their  character,  in  crossing  the  great  sea,  yet 
the  home -stayers  had  never  the  same  feeling  toward  the 
plantations  as  the  Greeks  had  towards  the  colonial  cities 
of  Magna  Grajcia.    If,  as  has  been  shrewdly  sumiised; 
Professor  Seely  was  lleroilotus  reincarnate,  how  grievoj 

171 


I>1t! 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

the  Bpirit  of  the  father  of  history  murt  h*ve  been  to  lay  of 
EngUahmen,  "  nor  have  we  even  now  ceased  to  think  of 
ourselves  as  simply  a  race  inhabiting  an  island  off  the 
northern  coast  of  the  Continent  of  Europe."  The  assump- 
tion of  gracious  superiority  which,  unless  carefully  cloaked, 
smacks  just  a  little  of  our  national  arrogance,  is  apt  to  jar 
on  sensitive  colonial  nerves.  With  the  expansion  of  the 
Empire,  and  the  supplanting  of  a  national  by  an  imperial 
spirit  this  will  become  impossible.  That  this  sentiment 
never  prevailed  in  Hellas,  as  it  did  later  in  the  Roman 
Empire,  was  due  largely  to  the  fact  that  in  literature,  m 
science  and  in  art,  the  colonial  cities  of  Greece  early  over- 
shadowed the  mother  cities.  It  may  be  because  the  settle- 
ments of  greater  Britain  were  of  slower  growth  that  it  rook 
several  generations  and  several  bitter  trials  to  teach  a 
lesson  the  Greeks  never  had  to  learn. 

The  Greek  spirit  was  the  leaven  of  the  old  world,  the 
workings  of  which  no  nationality  could  resist ;  thrice  it 
saved  western  civilisation,  for  it  had  the  magic  power  of 
leading  captivity  captive  and  making  even,  captive  con- 
querors the  missionaries  of  her  culture.  What  modern 
medicine  owes  to  it  wiU  appear  later.  "  The  love  of  science 
the  love  of  art,  the  love  of  freedom— vitally  correlat.:d  tc 
each  other,  and  brought  into  organic  union,"  were  the  essen- 
tial  attributes  of  the  Greek  genius  (Butcher).  While  we 
cannot  chiira  for  the  Anglo-Saxon  race  all  of  these  distinc- 
tions it  has  in  a  high  degree  that  one  which  in  pracxical 
life  is  the  most  valuable,  and  which  has  been  the  most 
precious  gift  of  the  race  to  the  world— the  love  of  freedom, 

Of  {i«edom  in  her  regal  seat 
Of  EngUnd. 

173 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
It  ^ould  carry  me  too  far  afield  to  discuas  the  differences 
between  the  native  Briton  and  his  chUdren  scattered  so 
widely  up  and  down  the  earth.  In  Canada,  South  Africa, 
Australia,  and  New  Zealand,  types  of  the  Anglo-Saxon 
race  are  developing  which  will  differ  as  much  from  each 
other,  and  from  the  English,  as  the  American  does  to-day 
from  the  original  stock ;  but  amid  these  differences  can 
everywhere  be  seen  those  race-qualities  which  have  made 
us  what  we  are—"  courage,  national  integrity,  steady  good 
sense,  and  energy  in  work."  At  a  future  meeting  of  the 
Association,  perhaps  in  Australia,  a  professional  Sir  Charles 
Dilke  with  a  firm  grasp  of  the  subject  may  deal  with  the 
medical  problems  of  Greater  Britain  in  a  manner  worthy 
of  the  ad(ii'iS8  in  medicine.  My  task,  as  I  meationed  at  the 
cuiflet,  is  much  less  ambitious. 

Could  some  one  with  full  knowledge  patiently  analyse 
the  characteristics  of  British  medicine,  he  would  find  certain 
national  traits  sufficiently  distinct  for  recognition.    Three 
centuries  cannot  accomplish  very  much  (and  that  period 
has  only  just  passed  since  the  revival  of  medicine  in  Eng- 
land), but  the  local  conditions  of  isolation,  which  have 
been  singulariy  favourable  to  the  development  of  special 
pecuUarities  'n  the  national  character,  have  not  been  with- 
out effect  in  the  medical  profession.    I  cannot  do  more 
than  touch  upon  a  few  features,  which  may  be  useful  as 
indicating  the  sources  of  influence  upon  Great  Britain  in 
the  past,  and  which  may  perhaps  be  suggestive  as  to  lines 
of  progress  in  the  future. 

Above  the  fireplace  in  Sir  Henry  Acland's  library  are 
three  panelled  portraits  of  Linacre,  Sydenham,  and  Harvey  ; 
the  scroll  upon  them  reads  LiUercs,  Praxis,  ScierUia.    To 

178 


li 


I   i 


1.0 


I.I 


2.8 

b 

<-      u 


2.5 
2.2 


2.0 


1.8 


MICROCOPY  RESOLUTION  TEST  CHART 

NATIONAL  BUREAU  OF  STANDARDS 

STANDARD  REFERENCE  MATERIAL  1010a 

(ANSI  and  ISO  TEST  CHART  No.  2) 


I 


I 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

this  great  triumvirate,  as  to  the  fountain  heads,  we  may 
trace  the  streams  of  inspiration  which  have  made  British 
medicine  what  it  is  to-day. 

Linacre,  the  type  of  the  literary  physician,  must  ever 
hold  a  unique  place  in  the  annals  of  our  profession.  To 
him  was  due  in  great  measure  the  revival  of  Greek  thought 
in  the  sixteenth  century  in  Englo  A  ;  and  in  the  last  Har- 
veian  oration  Dr.  Payne  has  pointed  out  his  importance 
as  a  forerunner  of  Harvey.  He  made  Greek  methods  avail- 
able ;  through  him  the  art  of  Hippocrates  and  the  science 
of  Galen  became  once  more  the  subject  of  careful,  first- 
hand study.  Linacre,  as  Dr.  Payne  remarks,  "  was  pos- 
sessed from  his  youth  till  his  death  by  the  enthusiasm  of 
learning.  He  was  an  idealist  devoted  to  objects  whicli  the 
world  thought  of  little  use."  Painstaking,  accurate^ 
critical,  hypercritical  perhaps,  he  remains  to-day  the  chief 
literary  representative  of  British  medicine.  Neither  in 
Britain  nor  in  Greater  Britain  have  we  maintained  the 
place  in  the  world  of  letters  created  for  us  by  Linacre's 
noble  start.  It  is  true  that  in  no  generation  since  has  the 
profession  lacked  a  man  who  might  stand  unabashed  in  the 
temple  at  Delos ;  but,  judged  by  the  fruits  of  learning, 
scholars  of  his  type  have  been  more  common  in  France  and 
Germany.  Nor  is  it  to  our  credit  that  so  little  provision  is 
made  for  the  encouragement  of  these  studies.  For  years 
the  reputation  of  (treat  Britain  in  this  matter  was  sustained 
almost  alone  by  the  great  Dee-side  scholar,  the  surgeon  of 
Banchory,  Francis  Adams— the  interpreter  of  Hippocrates 
to  English  students.  In  the  nineteenth  century  he  and 
Greenhill  well  maintained  the  traditions  of  Linacre.  Their 
work,  and  that  of  a  few  of  our  contemporaries,  among 

174 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 


1 


I 


whom  Ogle  must  be  specially  mentioned,  has  kept  ns  in 
touch  with  the  ancients.  But  by  the  neglect  of  the  study 
of  the  humanities,  which  has  been  far  too  general,  the 
profession  loses  a  very  precious  quality. 

While  iti  critical  scholarship  and  in  accurate  historical 
studies,  British  medicine  must  take  a  second  place,  the 
influence  of  Linacrc  exerted  through  the  Royal  College 
of  Physicians  and  the  old  Universities,  has  given  to  the 
hiunanities  an  important  part  in  education,  so  that  they 
have  moulded  a  larger  section  of  the  profession  than  in 
any  other  country.  A  physician  may  possess  the  science 
of  Harvey  and  the  art  of  Sydenham,  and  yet  there  may  be 
lacking  in  him  those  finer  qualities  of  heart  and  head  which 
count  for  so  much  in  life.  Pasture  is  not  everything  and 
that  indefinable,  though  well  understood,  something  which 
wc  know  as  breeding,  is  not  always  an  accompaniment  of 
great  professional  skill.  Medicine  is  scon  at  its  best  in  men 
whose  faculties  have  had  the  highest  and  most  harmonious 
culture.  Tlie  Lathams,  the  Watsons,  the  Pagets,  the 
Jenners,  and  the  Gairdners  have  influenced  the  profession 
less  by  their  special  work  than  by  exem]>lifying  those  graces 
of  life  and  refmements  of  heart  which  make  up  character. 
And  the  men  of  this  stamp  in  Greater  Britain  have  left 
the  most  enduring  mark,— Beaumont,  Bovell  and  Hodder 
in  Toronto ;  Holmes,  Campbell  and  Howard  in  this  city ; 
the  Warrens,  the  Jacksons,  the  Bigelows,  the  Bowditches, 
and  the  Shattucks  in  Boston  ;  Bard,  Hossack,  Francis, 
Clark,  and  Flint  of  New  York  ;  Morgan,  Shippen,  Redman, 
Rusli,  Coxe,  the  elder  Wood,  the  elder  Pepper,  and  the 
elder  Mitchell  of  Philadelphia— Brahmins  all,  in  the  lan- 
guage of  the  greatest  Brahmin  among  them,  Oliver  Wendell 

175 


i 


R1 


m. 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

Holme8.-these  and  men  like  unto  them  have  been  the 
leaven  which  has  raised  our  profession  above  the  dead  level 

of  a  business.  .     , 

The  liUercB  hurmniores,  represented  by  Linacrc.  revived 
Greek  methods  ;  but  the  Faculty  during  the  sixteenth  and 
at  the  beginning  of  the  seventeenth  centuries  was  m  a 
slough  of  ignorunce  and  self-conceit,  and  not  to  be  aroused 
even  by  Moses  and  the  prophets  in  the  form  of  Hippocraces 
and  the  fathers  of  medicine.    In  the  pictures  referred  to 
Sydenham  is  placed  between  Linacre  and  Harvey ;  but 
science  preceded  practice,  and  Harvey's  great  Lumleian 
lectures  were  delivered  before  Sydenham  was  born.  Lmacre 
has  been  weU  caUed.  by  Payne.  Harvey's  mtellectual  grand- 
father    "The  discovery  of  the  circulation  of  the  blood 
was  the  climax  of  that  movement  which  began  a  century 
and  a  half  before  with  the  revival  of  Greek  medical  classics 
and   especiaUy   of   Galen."    (Payne.)    Harvey   refomed 
to  Greek  methods  and  became  the  founder  of  modern  ex- 
perimental    physiology  and   the    great  glory  of    British 
scientific  medicine.    The  demonstration  of  the  circulation 
of  the  blood  remains  in  every  detail  a  model  research.     1 
shaU  not  repeat  the  oft-told  tale  of  Harvej-'s  great  and 
enduring  influence,  but  I  must  refer  to  one  feature  which, 
until  lately,  has  been  also  a  special  characteristic  of  his 
direct  successors  in  Great  Britain.    Harvey  was  a  practi- 
tioner   and   a  hospital   physician.    There   -«   gossipmg 
statements  by  Aubrey  to  the  effect  that     he  fell  mightily 
in  his  practice  "  after  the  publication  of  the  De  mtu  cord«. 
and  that  his  "  therapeutic  way '"  was  not  admued ;  but  to 
these  his  practical  success  is  the  best  answer.    It  is  rema.K- 
able  that  a  large  proportion  of  all  the  physiological  work 

176 


"& 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

of  Great  Britain  has  been  done  by  men  who  have  become 
successful  hospital  physicians  or  surgeons.  I  was  much 
impressed  by  a  conversation  with  Professor  Ludwig  in  1884. 
Speaking  of  the  state  of  English  physiology,  he  lamented 
the  lapse  of  a  favourite  English  pupil  from  science  to  prac- 
tice ;  but,  he  added,  "  while  sorry  for  him,  I  am  glad  for 
the  profession  in  England."  He  held  that  the  clinical 
physicians  of  that  country  had  received  a  very  positive 
impress  from  the  work  of  their  early  years  in  physiology 
and  the  natural  sciences.  I  was  surprised  at  the  list  of 
names  which  he  cited  ;  among  them  I  remember  Bowman, 
Paget,  Savory  and  Lister.  Ludwig  attributed  this  feature 
in  part  to  the  independent  character  of  the  schools  in  Eng- 
land, to  the  absence  of  the  University  element  so  important 
in  medical  life  in  Germany,  but,  above  all,  to  the  nractical 
character  of  the  English  mind,  the  better  men  preferring 
an  active  life  in  practice  to  a  secluded  laboratory  career. 

Thucydidea  it  was  who  said  of  the  Greeks*  that  they 
possessed  "  the  power  of  thinking  before  they  acted,  and 
of  acting,  too."  The  same  is  true  in  a  high  degree  of  the 
EngUsb  race.  To  know  just  what  has  to  be  done,  then  to 
do  it,  comprises  the  whole  philosophy  of  practical  life. 
Sydenh&m—AnglicB  lumen,  as  he  has  been  well  called— is  the 
model  practical  physician  of  modern  times.  Linacre  led 
Harvey  back  to  Galen,  Sydenham  to  Hippocrates.  The 
one  took  Greek  science,  the  other  not  so  much  Greek  medi- 
cine as  Greek  methods,  particularly  intellectual  fearlessness, 
and  a  certain  knack  of  looking  at  things.  Sydenham 
broke  with  authority  and  went  to  natm-e.  It  is  an  extra- 
ordinary fact  that  he  could  have  been  so  emancipated 
from  dogmas  and  theories  of  all  sorts.    He  laid  down  the 

Aau  177  K 


I 


inu 


r=    i  I 


'ih    k 


:      .1 


m 

m 

ilBS 

!^M 

WM'i 

^m\\ 

!' 

! 

BRITISH  MEDICINE  IN  GREATER  BRITAIN 
tatomenUl  proporition.  and  .etod  upon  it,  th.t-'ril 
ai.e«e,  should  be  d«oribed  »  objert.  ol »  »^^^J^ 
To  do  him  jostioe  we  mmt  remember,  as  Dr.  John  Brown 
„y.,"  in  tie  mid.tolwhatam«soI  errors  and  pre)«d.e». 

of  fteories  actively  mischievous,  he  was  ph>.*d,  at  a  tune 
when  the  mania  ol  hypothec  was  at  its  height  and  when 
the  practical  part  of  his  art  was  overrm.  and  stultified  by 
^lU'X  nostrums."    Sydenham  led  us  back  to  H^- 
I^tes  I  wo«ld  that  we  could  be  led  oltener  to  Sydenham ! 
I^r^Lessary  to  bear  in  mind  what  h.  says  abou.  the 
ZJ.I  the  study  of  medicine.    "  In  writing  therefore, 
^th  a  natural  history  of  diseases,  every  merel,  phJoso_ 
IL  hypothesU  should  be  set  aside,  and  the  mamf est  and 
S^-omena,  however  minute,  should  be  noted  with 
Z  utnfost  exactness.    The  usefulne.  of  t^»  P-^^ 
cnnot  be  easily  overrated,  as  compared  with  the  subtle 
b^es  and  tkg  notions  of  modem  writers,  for  can 
S«  be  a  shorter,  or  indeed  any  other  way  oi  coming  a 
"bific  causes,  or  discovering  the  curative  icd-.tion^ 
thi    by  a  certain  perception  of  the  pecdiar  syrnptoms  1 
B^fteL  steps  and  helps  it  was  that  the  father  of  physic, 
fr^tt  Bppoc^tes,  came  to  excel,  his  th-y  ^eing  no 
* Lthan  an  exact  description  nr  view  -A  Natuie.    He 
Cd  that  Nature  alone  ot«.a  termmates  d»eases.  and 
ZL  a  core  with  a  few  simple  medicines,  and  often  enough 
r^n  m^cines  at  all."    WeU  indeed  has  a  recent  ™ter 
larked,  "  Sydenham  is  -^"e  every  previous  ^ach«o. 
th,  principles  and  prartice  of  medicme  m  *«  ^^r^^ 
world"    He,  not  linacre  or  Harvey,  is  the  model  British 
^H^ian  in'whom  were  -centrated  aU  those  J.a<.^> 
Lcincts  upon  which  we  lay  such  stress  m  the  Anglo-Saxon 

character.  ^^ 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

The  Greek  faculty  which  we  possess  of  ttinking  and 
acting  has  enabled  us,  in  spite  of  manjr  disadvpntages,  to 
take  the  lion's  share  in  the  great  practical  advances  in 
medicine.  Three  among  the  greatest  scientific  movements 
of  the  century  have  come  from  Germany  and  France. 
Bichat,  Laennec  and  Louis  laid  the  foundation  of  modern 
clinical  medicine ;  Virchow  and  his  pupils  of  scientific 
pathology ;  wLUe  Pasteur  and  Koch  have  revolutionized 
the  study  of  the  causes  of  disease ;  and  yet,  ihe  modem 
history  of  the  art  of  medicine  could  almost  be  writtri  in  its 
fulness  from  the  records  of  the  Anglo-Saxon  race.  We 
can  claim  every  practical  advance  of  the  very  first  rank — 
vaccination,  anaesthesia,  p  'eventive  medicine  and  antiseptic 
surgery,  the  '*  captain  jewels  in  the  carcanet"  of  the  pro- 
fession, beside  which  can  be  placed  no  others  of  equal  lustre. 

One  other  lesson  of  Sydenham's  life  needs  careful  con- 

ninj.    The  English  Hippocrates,  as  I  said,  broke  with 

authority.    His  motto  was 

Thcu  Nature  art  my  Goddess ;  to  thy  law 
My  serri  <s  are  bound. 

Undue  reverince  for  authority  as  such,  a  serene  satisfac- 
tion with  the  status  quo,  and  a  fatuous  objection  to  change 
have  often  retarded  the  progress  of  medicine.  In  every 
geuTation,  in  every  country,  there  have  been,  and  ever 
will  be,  laudatores  h  uporia  acti,  in  the  bad  sense  of  that 
phrase,  not  a,  it/r  oi  them  men  in  high  places,  who  have 
lent  the  weight  of  a  complacent  conservatism  to  bolster 
up  an  ineffectual  attempt  to  stay  the  progress  of  new  ideas. 
Every  innovator  from  Harvey  to  Lister  has  been  made  to 
feel  its  force.  The  recently  issued  life  of  Thomas  Wakley 
is  a  running  commentary  on  this  spirit,  against  the  pricks 

179 


1    t 

ii 

BRITISH  MEDICINE  IN  GREATER  BRITAIN 

of  which  he  kicked  80  hard  and  so  efiectuaUy.    But  there 
are  signs  of  a  great  change.    The  old  universities  and  the 
coUeges.  once  the  chief  offenders,  have  been  emancipated, 
and  remain  no  longer,  as  Gibbon  found  them,  steeped  m 
port  and  prejudice.    The  value  of  authority  per  se  has 
lessened  enormously,  and  we  of  Greater  Britam  have  per- 
haps  suffered  as  the  pendulum  has  swung  to  the  other 
extreme.    Practice  loves  authority,  as  announced  m     the 
general  and  perp3tual  voice  of  men."    Science  must  ever 
Jold   V       ^^  -harmus  that  a  judicious  distrust  and  wise 
3cep'^  Che  sinews  of  the  understanding.    And  yet 

the  V    '  *ti"^*  °*  ^^^'^^ '"  *^"'°**  everything  relating 

to  oar  arc  rest  v.  on  authority.    The  practitioner  camiot 
always  be  the  judge;  the  responsibUity  must  often  rest 
with  the  teachers  and  investigators,  who  can  only   earn 
in  the  lessons  of  history  the  terrible  significance  of  the 
word     The  fetters  of  a  thousand  years  in  the  treatment 
of  fever  were  shattered  by  Sydenham,  shattered  only  to  be 
riveted  anew.    How  hard  was  the  battle  in  this  century 
against  the  entrenched  and  stubborn  foe !    Listen  to  the 
eloquent  pleadings  of  Stokes,  pleading  as  did  Sydenham, 
against  authority,  and  against  the  bleedings  the  purgings 
and  sweatings  of  fifty  years  ago.    "Though  his  hair  be 
srey  and  his  authority  high,  he  is  but  a  child  in  knowledge 
Ind  his  reputation  an  error.    On  a  level  with  a  child,  so 
far  as  correct  appreciation  of  the  great  truths  of  medicme 
is  concerned,  he  is  very  different  in  other  respects   his 
powers  of  doing  mischief  are  greater  ;  he  is  far  more  dan^ 
eerous     Oh  !  th  ^  men  would  stoop  to  learn,  or  at  least 
cease  to  destroy."      The  potency  of  hmnan  authority 
among  the  powers  that  be,  was  never  better  drawn  than 

180 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 


by  the  judicious  Hooker  in  his  section  on  this  subject. 
"  And  this  not  only  with '  the  simpler  sort,'  but  the  learneder 
and  wiser  we  are,  the  more  such  arguments  in  some  cases 
prevail  with  us.  The  reason  why  the  simpler  sort  are 
moved  with  authority  is  the  conscience  of  their  own  ignor- 
ance ;  whereby  it  cometh  to  pass  that  haviiig  learned  men 
in  admiration,  they  rather  fear  to  dislike  them  than  know 
wherefore  they  should  allow  and  follow  their  i"''  Tnonts. 
Contrariwise  with  them  that  are  skilful  authority  is  much 
more  strong  and  forcible ;  because  they  only  are  able  to 
discern  how  just  cause  there  is  why  to  some  men's  authority 
so  much  should  be  attributed.  For  which  cause  the  name 
of  Hippocrates  (no  doubt)  were  more  effectual  to  persuade 
even  such  men  as  Galen  himself  than  to  move  a  silly 
empiric."  ' 

SydenLam  was  called  "  a  man  of  many  doubts  "  and 
therein  lay  the  secret  of  his  great  strength. 

II 

Passing  now  to  the  main  question  of  the  development 
of  this  British  medicine  in  Greater  Britain,  I  must  at  once 
acknowledge  the  impossibility  of  doing  justice  to  it.  I  can 
only  indicate  a  few  points  of  importance,  and  I  must  con- 
fine my  remarks  chiefly  to  the  American  part  of  Greater 
Britain.  We  may  recognize  three  distinct  periods  corres- 
ponding to  three  distinct  waves  of  influence,  the  first  from 
the  early  immigration  to  about  1820,  the  second  from 
about  1820  to  1860,  and  the  third  from  about  1860  to  the 
present  time. 

The  colonial  settlements  were  contemporaneous  with 
the  revival  of  medicine  in  England.     Fellow-scudpnts  of 
>  Ecclesiastical  Polity.    Book  ii..  vii.  2. 
181 


]      ' 


'  S 


I 


I!) 
11 


i   t 


ill; 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
♦  p^mhridM  miKht  have  BaUed  in  the  Mayflower 
^Il^t^.^«  -"^y  punned  exp^tioM 

„d  the  early  "^^^^^^^g  „fe«nee,  to  th.« 
^lonie.    conum  many  «^'^8  ^  ^^^ 

Zttd  wK   'co^n  Mather  ealled  an  "  angeUea.  con- 
Uuettatea  w  ^._^^  ^^  ^^  ^,  ^^^  »,, 

r  °L  sWUn  P%«o4  ha.  been  taqnently  profe«ed 

and  practised  "y  "        „  _         ^i^it,  finding  physic 
„.,  the  study  of  Dmnity^  F'™-  ^^y. 

".'"^'irrNefEng^nd  Inie.  .ere  »=hoUriy  »ble 
sicians  in  *«  «»"  '^        ;„  Ha«thon.e's  .■Jcorto  lelW, 

■"".  ''T;  t^efTa  s'  -t,^^  o"  his  own  l«e :  "  Made  up 

n;r.:s::bUbt..,,uietyeji.^to«d 

1 1:^  carhig  Uttie  .r  theniseiv.,  ^^a^^J  --^, 
of  constant  if  not  warm  affections.-   asingui     y 

n:;l"««—5tSschooU  (University 
/^i:y;snia,ne..Ki.-sCoUege(^^^^^^^ 

l%en  trained  und.t.^^^^-tr.:: 

:rr:c:rcirsu:.onphada.o,. 


BR1TT«»H  MEDICINE  IN  GREATER  BRITAIN 

powerful  effect  in  moulding  profewional  life  in  the  pre- 
revolutionary  period.  They  were  men  who  had  enjoyed 
not  alone  the  instruction  but  often  the  intimate  friendship 
of  tho  great  English  and  European  physicians.  Morgan, 
Rush,  Shippen,  Bard,  Wistar,  Hossack  and  others  had 
received  an  education  comprising  all  that  was  best  in  the 
period,  and  had  acquired  the  added  culture  which  can  only 
come  from  trtvel  and  wide  acquaintance  with  the  world. 
Morgan,  the  founder  of  the  medical  school  of  the  University 
of  Pennsylvania,  was  u  way  seven  years,  and  before  return- 
ing had  taken  his  seat  as  .t  corresponding  meriiber  of  the 
French  Acader  y  of  Sur  rr.  h(  'des  having  been  elected 
a  Fellow  of  the  Royal  H«)ciety  I'he  War  of  Independence 
interrupted  temporarily  the  stivam  of  students,  but  not 
the  friendship  which  existed  b^''*«*'n  Cull»>n  ar.d  Fothergill 
and  their  old  pu^iilH  in  Arae;  ^^     correspondence  of 

these  two  warm  friends  of  the  ^  estifies  to  the  strong 

professional  intimacy  whicli  ex       i  at  the  time  between 
the  loaders  of  the  profession  in  i       old  and  new  worlds. 

But  neither  Boerhaave,  Cullcs 
colonial  medicine  as  did  the  great 
Long,  weary  centuries  separated  Ha         troui  Uabii ;  not 
a  century  elapsed   from  the  death  grent  physi- 

ologist to  the  advent  of  the  man  i 
personality  may  be  seen  all  the  distinct 
medicine,  and  the  range  of  whose  mighty   iit^ 
few,  ii  any,  equals  since  Aristotle.    Hun''='r" 
the  profession  of  this  continent,  so  deep  :    d  e 
exerted  in  three  ways.    In  the  first  plai      his 
army  surgeon,  and  his  writings  on  su      ct 
interest  to  military  men,  carried  his  wurk  ana  ^vays  intt 

183 


r  Fnthergill  stamped 
<m&\.    Tohn  Hunter. 


h 


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111 


rtmenal 

levn 

lad 

on 

tv.u%    was 

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Mr 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

innumerable  campaigns  in  the  \  g  French  wars  and  in  the 
War  of  Independence.    Hunter  s  works  were  reprinted  in 
America  as  early  as  1791  and  1793.    In  the  second  place, 
Hunter  had  a  number  of  most  distinguished  students  from 
the  colonies,  among  whom  were  two  who  became  teachers 
of  wide  reputation.    William  Shippen,  the  first  Professor 
of  Anatomy  in  the  University  of  Pennsylvania,  lived  with 
Hunter  on  terms  of  the  greatest  intimacy.    He  brought 
back  his  methods  of  teaching  and  some  ir-asure  of  his 
spirit.    With  the  exception  of  Hewson  and  Home,  Hunte 
had  no  more  distinguished  pupil  than  Philip  Syng  f-iysick, 
who  was  hia  house  surgeon  at  St.  George's  Hospital,  and 
his  devoted  friend.    For  more  than  a  j_-i  ration  i  h.dick 
had  no  surgical  compeer  in  America,  and  eiijoyed  a  reputa- 
tion equalled  by  no  one  save  Rush.    He  taught  Hunterian 
methods  in  the  largest  medical  school  in  the  country,  and 
the  work  of  his  nephew  (Dorsey)  on  Surgery  is  very  largely 
Hunter  modified  by  Physick.    But  in  a  third  and  much 
more  potent  way  the  great  master  influenced  the  profession 
of  this  continent.    Hunter  was  a  naturalist  to  whom  path- 
ological processes  were  only  a  small  part  of  a  stupendous 
whole,  governed  uy  law,  which,  however,  could  never  be 
understood  until  the  facts  had  been  accumulated,  tabu- 
lated and  systematized.    By  his  example,  by  his  prodigious 
industry,  and  by  his  suggestive  experiments  he  led  men 
again  into  the  old  paths  of  Aristotle,  Galen  and  Harvey. 
He  made  all  thinking  physicians  naturalists,  and  he  lent  a 
dignity  to  the  study  of  organic  life,  and  re-established  a 
close  union  between  medicine  and  the  natural  £  'ences. 
Both  in  Britain  and  Greater  Britain  ho  laid  the  foundation 
of  the  great  coUectior.'^  and  museums,  particularly  those 

184 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 


connected  with  the  medical  schools.  The  Wistar-Horner 
and  the  Warren  museumj  originated  with  men  who  had 
been  greatly  influenced  by  Hunter.  He  was,  moreover, 
the  intellectual  father  of  that  interesting  group  of  men  on 
this  side  of  the  Atlantic  who,  while  practising  as  physicians, 
devoted  much  time  and  labour  to  the  study  of  Natural 
History.  In  the  latter  part  of  the  last  century  and  during 
the  first  thirty  years  of  this,  the  successfa)  practitioner 
was  very  often  a  '^aturalist.  I  wish  that  time  permitted 
me  to  do  justice  zo  the  long  list  of  men  who  have  been 
devoted  naturalists  and  who  have  made  contributions  of 
great  velue.  Benjamin  Smith  Barton,  David  Hossack, 
Jacob  Bigelow,  Richard  Harlan,  John  D.  Godman,  Samuel 
George  Morton,  John  Collins  Warrea,  Samuel  L.  Mitchill 
J.  Aiken  Meigs  and  many  others  have  left  the  records  of 
their  industry  in  their  valuable  works  and  in  the  Transac- 
tions of  the  various  societies  and  academies,  '^n  Cana  , 
many  of  our  best  naturalists  have  been  physicians,  and 
collections  in  this  city  testify  to  the  industry  of  Holmes 
and  McCullough. 

I  was  regretti  g  the  humanities  a  few  minutes  ago,  and 
now  I  have  to  raourn  the  almost  complete  severance  of 
medicine  from  the  old  natural  history.  To  a  man  the 
most  delightful  recollections  of  whose  student  life  are  the 
Saturdays  spent  with  a  preceptor  who  had  a  Hunterian 
appetite  for  specimens — anything  from  a  trilobite  to  an 
acarus — to  such  a  one  across  the  present  brilliant  outlook 
comes  the  shadow  of  the  thought  that  the  conditions  of 
progress  will  make  impossible  again  such  careers  as  those  of 
William  Kitchen  Parker  and  William  Carmichael  Mcintosh. 

Until  about  1820  the  English  profession  of  this  continent 

185 


I!  .? 
A 


I  i 


1'  i 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
kaew  little  else  than  British  medicine.    After  this  date  in 
the  United  States  the  ties  of  professional  union  with  the 
old  country  became  relaxed,  owing  in  great  part  to  the 
increase  in  the  number  of  home  schools,  and  in  part  to  the 
development  of  American  literature.    To  1820  one  hundred 
and  fourteen  native  medical  books  of  all  kinds  had  been 
issued  from  the  press,  and  one  hundred  and  thirty-one 
reprints  and  translations,  the  former  English,  the  latter, 
few  in  number,  and  almost  exclusively  French  (Billings). 
Turning  for  a  few  minutes  to  the  condition  of  the  profes- 
sion in  Canada  during  this  period,  I  regret  that  I  cannot 
speak  of  the  many  interesting  questions  relating  to  the 
French  colonies.    With  the  earliest  settlers  physicians  had 
come,  and  among  the  Jesuits,  in  their  devoted  missions, 
there  are  records  of  donnes  (laymen  attached  to  the  service), 
who  were  members  of  the  profession.    One  of  these,  Ren6 
Goupil,  suffered  martyrdom  at  the  hands  of  the  Iroquois.* 

Between  the  fall  of  Quebec  in  1759  and  1820,  the  English 
population  had  increased    by  the  settlement   of  Upper 
Canada,  chiefly  by  United  Empire  loyalists  from  the  United 
States,  and  after  the  war  of  1812  by  settlers  from  the  old 
country.    The  physicians  in  the  sparsely  settled  districts 
were  either  young  men  who  sought  their  fortunes  in  the 
new  colony  or  were  army  surgeons,  who  had  remained  after 
the  revolutionary  war  or  the  war  of  1812.    The  military 
element  gave  for  some  years  a  very  distinctive  stamp  to 
the  profession.    These  surgeons  were  men  of  energy  and 
ability,  who  had  seen  much  service,  and  were  accustomed 
to  order,  discipline  and  regulations.    Sabine,  in  his  Ameri- 
qan  Loyalists,  refers  to  the  Tory  proclivities  of  the  doctors, 
1  Workman.    Jesuits  in  North  America. 


» 


■^ 


4 

1 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

but  says  that  they  were  not  so  much  distux^  .*  as  the 
lawyers  and  clergymen.  Still  a  good  many  of  them  left 
their  homes  for  conscience'  sake,  and  Canniff ,  in  his  Medical 
Profession  in  Upper  Canada,  gives  a  list  of  those  known 
to  have  been  among  the  United  Empire  Loyalists. 

The  character  of  the  men  who  controlled  the  profession 
of  the  new  colony  is  well  shown  by  the  proceedings  of  the 
Medical  Board  which  was  organized  in  1819.    Drs.  Ma- 
caulay  and  Widmer,  both  army  surgeons,  were  the  chief 
members.    The  latter,  who  has  well  been  termed  the  father 
of  the  profession  in  Upper  Canada,  a  man  of   the  very 
highest  character,  did  more  than  anyone  else  to  promote 
the  progress  of  the  profession ;  and  throughout  his  long 
career  his  efforts  were  always  directed  in  the  proper  channels; 
In  looking  through  CannifE's  most  valuable  work  one  is 
much  impressed  by  the  sterling  worth  and  mettle  of  these 
old  army  surgeons  who  in  the  early  days  formed  the  larger 
part  of  the  profession.    The  minutes  of  the  Medical  Board 
indicate  with  what  military  discipline  the  candidates  were 
examined,  and  the  percentage  of  rejections  has  probably 
never  been  higher  in  the  history  of  the  province  than  it 
was  in  the  first  twenty  years  of  the  existence  of  the  Board. 

One  picture  on  the  canvas  of  those  early  days  lingers  in 
the  memory,  illustrating  all  the  most  attractive  features 
of  a  race  which  has  done  much  to  make  this  country  what 
it  is  to-day.  Widmer  was  the  type  of  the  dignified  old 
army  surgeon,  scrupulously  punctilious  and  in  every  detail 
regardful  of  the  proprieties  of  life.  "  Tiger  "  Dunlop  may 
be  taken  as  the  very  incarnation  of  that  restless  roving 
spirit  which  has  driven  the  Scotch  broadcast  upon  the 
world.    After  fighting  with  the  Connaught  Rangers  in  the 

187 


! 


-I 

n 


It 

V 


It 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

war  of  1812,  campaigning  in  India,  clearing  the  Saugur  of 
tigers — hence  his  soubriquet  "  Tiger,"  lecturing  on  Medical 
Jurisprudence  in  Edinburgh,  writing  for  Blackwood,  editing 
the  British  Press  and  the  Telescope,  introducing  Beck's 
Medical  Jurisprudence  to  English  readers,  and  figuring  as 
director  and  promoter  of  various  companies,  this  extra- 
ordinary character  appears  in  the  young  colony  as  "  Warden 
of  the  Black  Forest "  in  the  employ  of  the  Canada  Com- 
pany. His  life  in  the  backwoods  at  Gairbraid,  his  Noctes 
AmbrosiancB  Canadenses,  his  famous  "  Twelve  apostles," 
as  he  called  his  mahogany  liquor  stand  (each  bottle  a  full 
quart),  his  active  political  life,  his  remarkable  household, 
his  many  eccentricities — are  they  not  all  portrayed  to  the 
life  in  the  recently  issued  In  the  days  of  the  Canada  Com- 
pany? 

Ill 

Turning  now  to  the  second  period,  we  may  remark  in 
passing  that  the  nineteenth  century  did  not  open  very 
auspiciously  for  British  medicine.  Hunter  had  left  no 
successor,  and  powerful  as  had  been  his  influence  it  was 
too  weak  to  stem  the  tide  of  abstract  speculation,  with 
which  Cullen,  Brown,  and  others  flooded  the  profession. 
No  more  sterile  period  exists  than  the  early  decades  of 
this  century.  Willan  (a  great  naturaUst  in  skin  diseases) 
with  a  few  others  saved  it  from  utter  oblivion.  The  methods 
of  Hippocrates,  of  Sydenham,  and  of  Hunter  had  not  yet 
been  made  available  in  everyday  work. 

The  awakening  came  in  France,  and  such  an  awakening  ! 
It  can  be  compared  with  nothing  but  the  renaissance  in 
the  sixteenth  and  seventeenth  centuries,  which  gave  us 
Vesalius  and  Harvey.    "Citizen"  Bichat  and  Broussais 

188 


II 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

led  the  way,  but  Laennec  really  created  clinical  medicine 
as  we  know  it  to-day.    The  discovery  of  auscultation  was 
only  an  incident,  of  vast  moment  it  is  true,  in  a  systematic 
study  of  the  correlation  of  sjrmptoms  with  anatomical 
changes.    Louis,  Andral,  and  Chomel,  extended  the  reputa- 
tion of  the  French  school  which  was  maintained  to  the  full 
until  the  sixth  decade,  when  the  brilliant  Trousseau  ended 
for  a  time  a  long  line  of  Parb  teachers,  whose  audience  had 
been  world-wide.    The  revival  of  medicine  in  Great  Britain 
was  directly  due  to  the  French.    Bright  and  Addison, 
Graves  and  Stokes,  Forbes  and  Marshall  Hall,  Latham  and 
Bennett  were  profoundly  affected  by  the  new  movement. 
In  the  United  States  Anglican  influence  did  not  wane  until 
after  1820.    Translations  of  the  works  of  Bichat  appeared 
as  early  as  1802,  and  there  were  reprints  in  subsequent 
years,  but  it  was  not  until  1823  that  the  first  translation 
(a  reprint  of  Forbes'  edition)  of  Laennec  was  issued.    Brous- 
sais'  works  became  very  popular  in  translations  after  1830, 
and  in  the  journals  from  this  time  on  the  change  of  allegi- 
ance became  very  evident.    But  men  rather  than  books 
diverted  the  trend  of  professional  thought.    After  1825, 
American  students  no  longer  went  to  Edinburgh  and  Lon- 
don, but  to  Paris,  and  we  can  say  that  between  1830  and 
1860,  every  teacher  and  writer  of  note  passed  under  the 
Gallic  yoke.    The  translations  of  Louis'  works  and  the 
extraordinary  success  of  his  American  pupils,  a  band  of 
the  ablest  young  men  the  country  had  ever  seen,  added 
force  to  the  movement.    And  yet  this  was  a  period  in 
which  American  medical  literature  was  made  up  largely 
of  pirated  English  books,  and  the  systems,  encyclopedias, 
and  libraries,  c^-iefly  reprints,  testify  to  the  zeal  of  the 

189 


■    \ 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
publiBhers.    Stokes.  Graves.  Watson.  Todd.  Bennett,  and 
Williams,  furnished  AngUcan  j  ^  to  the  sucklings,  a.   ^eU 
as  strong  meat  to  the  fuU  grown.    In  spite  of  the  poweriul 
French  influence  the  text  books  of  the  schoob  were  almost 

exclusively  English. 

In  Canada  the  period  from  1820  to  1860  saw  the  estab- 
lishment of  the  English  universities  and  medical  .whools. 
In  Montreal  the  agencies  at  work  were  whoUy  Scotch. 
The  McGill  Medical  School  was  organized  by  Scotchmen, 
and  from  its  inception  has  Mowed  closely  Edinburgh 
methods.    The  Paris  influence,  less  personal,  was  exerted 
chiefly  through  English  and  Scotch  channels.    The  Upper 
Canada  schools  were  organized  by  men  with  Enghsh  affiha- 
tions.  and  the  traditions  of  Guy's.    St.   Bartholomews. 
St  Thomas's,  St.  George's,  and  o?  the  London  Hospital, 
rather  than  those  of  Edin'ourgh.  have  prevaUed  m  Toronto 

and  Kingston. 

The  local  French  influence  on  British  medicme  m  Canada 
has  been  very  sUgat.    In  the  early  decades  of  the  century, 
when  the  cities  were  smaller,  and  the  intercourse  between 
the  French  and  English  8omewhat  closer,  the  reciprocal 
action  was  more  marked.    At  that  period  EngUsh  methods 
became  8omewh.%t  the  vogue  among  the  French ;  several 
very  prominent  French  Canadians  were  Edinburgh  gra- 
duates.   Attempts  were  made  in  the  medical  journals  tc 
have  communications  in  both  languages,  but  the  fusion  of 
the  two  sections  of  the  profession  was  no  more  feasible  than 
th.  fusion  of  the  two  nationalities,  and  the  development 
has  progressed  along  separate  lines. 

The  third  period    ^tes  from  about  1860  when  the  influ- 
ence of  German  medicine  began  to  be  felt.    The  rise  of  the 

190 


'W 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

Vienna  Bchool  was  for  a  bng  time  the  only  visible  result  in 
Germany  of  the  French  renaissance.  Skoda,  the  German 
Laennec  and  Rok^tansky,  the  German  Morgagni,  influenced 
Lnglish  and  American  thought  between  1840  and  1860, 
bat  it  was  not  until  after  the  last  date  that  Teutonic  medi- 
cine began  to  be  felt  as  a  vitalizing  power,  chiefly  through 
the  energy  of  Virchow.  After  the  translation  of  the  Cellu- 
lar Pathology  by  Chance  (1860)  the  way  lay  clear  and  open 
to  every  young  student  who  desired  inspiration.  There 
had  been  great  men  in  Berlin  before  Virchow,  but  he  made 
the  town  on  the  Spree  a  Mecca  for  the  faithful  of  all  lands. 
From  this  period  we  can  date  the  rise  of  German  influence 
on  che  profession  of  this  continent.  It  came  partly  through 
vhe  study  of  pathological  histology,  under  the  stimulus 
given  by  Virchow,  and  partly  through  the  development  of 
the  specialities,  particularly  diseases  of  the  eye,  of  the  skin 
an''  of  the  larynx.  The  singularly  attractive  courses  of 
H>  ,  the  organization  on  a  large  scale  in  Vienna  of  a 
systtim  of  graduate  teaching  designed  especially  for  f  r  reigners 
and  the  remarkable  expansion  of  the  German  laboratories 
combined  to  divert  the  stream  of  students  from  France. 
The  change  of  allegiance  was  a  deserved  tm  ute  to  the 
splendid  organization  of  the  German  universities,  to  the 
untiring  zeal  and  energy  of  their  professors  and  to  their 
single-minded  devotion  to  science  for  its  own  sake. 

In  certain  aspects  the  Australasian  Settlements  present 
the  most  interesting  problems  of  Greater  Britain.  More 
homogeneous,  thoroughly  British,  isolated,  distant,  they 
must  work  out  their  destiny  with  a  less  stringent  environ- 
ment, than,  for  example,  surrounds  the  English  in  Canada. 
The  traditions  are  more  uniform  and  of  whatever  character 

191 


H 


i: 


!■ 


i' 


1 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
have  filtered  through  British  channels.    The  professional 
population  of  native-trained  men  is  as  yet  small,  and  the 
proportion  of  graduates  and  Ucentiates  from  the  English, 
Scotch  and  Irish  colleges  and  boards  guarantees  a  domi- 
nance of  Old  Country  ideas.    What  the  maturity  wiU 
show  cannot  be  predicted^  but  the  vigorous  infancy  is  full 
of  crescent  promise.    On  looking  over  the  fUes  of  Australian 
and  New  Zealand  journals,  one  is  anpressed  with  the  mono- 
tonous simUarity  of  the  diseases  in  the  antipodes  to  those 
of  Great  Britain  and  of  this  continent.    Except  in  the 
matter  of  parasitic  afEections  and  snake-bites,  the  nosology 
presents  few  distinctive  quaUties.    The  proceedings  of  the 
four  Intercolonial  Congresses  indicate  a  high  level  of  pro- 
fessional thought.    In  two  points  Australia  has  not  pro- 
gressed as  other  parts  of  Greater  Britain.    The  satisfactory 
regulation  of  practice,  so  early  settled  in  Canada,  has  been 
beset  with  many  difficulties.    Both  in  the  United  States 
and  in  AustraUa  the  absence  of  the  military  element,  which 
was  so  strong  in  Canada,  may  in  part  at  least  account  for 
the  great  difference  which  has  prevailed  in  this  matter  of 
the  state  licence.    The  other  relates  to  the  question  of 
ethics,  to  which  one  really  does  not  care  to  refer,  were  it 
not  absolutely  forced  upon  the  attention  in  reading  the 
journals.     Elsewhere    professional    squabbles,  always  so 
unseemly  and  distressing,  are  happily  becoming  very  rare, 
and  in  Great  Britain,  and  on  this  side  of  the  water,  we  try 
at  any  rate  "  to  wash  our  dirty  linen  at  home."    In  the 
large  Australian  cities,  differences  and  dissensions  seem 
lamentably  common.    Surely  they  must  be  fomented  by 
the  atrocious  system  of  elections  to  the  hospitals,  which 
plunges  the  entire  profession  every  third  or  fourth  year 
^  192 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

into  the  throes  of  a  contest,  in  which  the  candidates  have 
to  eolicit  the  sufbrages  of  from  2,000  to  4,000  voters !  Well, 
indeed,  might  Dr.  Batchelor,  say,  in  his  address  at  the 
fourth  Intercolonial  Congress  :  "  It  is  a  scandal  that  in  any 
British  community,  much  less  in  a  community  which  takes 
pride  in  a  progressive  spirit,  such  a  pernicious  system 
should  survive  for  an  hour." 

Of  India,  of  "  Vishnu-land,"  what  can  one  say  in  a  few 
minutes  ?  Three  thoughts  at  once  claim  recogniticn. 
Here  in  the  dim  dawn  of  history,  with  the  great  Aryan 
people,  was  the  intellectual  cradle  of  the  world.  To  the 
Hindoos  we  owe  a  debt  which  we  can  at  any  rate  acknow- 
ledge ;  and  even  in  medicina,  many  of  our  traditions  and 
practices  may  be  traced  to  them,  as  may  be  gathered  from 
that  most  interesting  History  of  Aryan  Medical  Science,  by 
the  Thakore  Saheb  of  Gondal. 

Quickly  there  arises  the  memory  of  the  men  who  have 
done  so  much  for  British  medicine  in  that  great  empire. 
Far  from  their  homes,  far  from  congenial  surroundings, 
and  far  from  the  stimulus  of  scientific  influences,  Annesley, 
Ballingall,  Twining,  Morehead,  Waring,  Parkes,  Cunning- 
ham, Lewis,  Vandyke  Carter,  and  many  others,  have  up- 
held the  traditions  of  Harvey  and  of  Sydenham.  On  the 
great  epidemic  diseases  how  impoverished  would  our  litera- 
ture be  in  the  absence  of  their  contributions !  But  then 
there  comes  the  thought  of  "  the  petty  done,  the  undone 
vast,"  when  one  considers  the  remarkable  opportunities  for 
study  which  India  has  presented.  W'lere  else  in  the  world 
is  there  such  a  field  for  observation  in  cholera,  leprosy, 
dysentery,  the  plague,  typhoid  fever,  malaria,  ind  in  a 
host  of  other  less  important  maladies.    And  what  has  the 

AE.  193  o 


li 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 
Britiri.  Gov«nment  done  tow«d.  the  «»nti8o  b«»tig.- 
tio.  .f  the  <U«»«  of  iBdia?    Beta  rec^Uy  Utile  or 
nothing,  .nd  the  ptopo«l  to  foond  an  mtrtute  I»    he 
KieSc  Btudy  oi  di«.w  has  actuaUy  come  from  the 
^S^hief. !    The  work  of  Dr.  Hankin  and  of  Professor 
^kine.  and  the  not  nnmUed  evil  of  f'':™'' jf^ 
of  plague  in  Bombay,  may  aronse  the  offie^l.  to  a  con- 
„io«s^  of  their  shortcomings.    WhUe  ssjuUry  progr^ 
L  been  great  as  shown  in  a  reduction  oi  the  morta  .ty 
from  sixty  nine  per  mille  before  1857  to  fifteen  per  n^dle^ 
.resent,  many  problems  are  stiU  urgent,  «  may  be  gathe^ 
from  r^ing  Dr.  Harvey's  Presidental  »dd«»  -d  *« 
proceedings  o<  the  Indian  Medical  c„ngr»s.    That  l^ho^ 
fever  can  be  called  the  "  K>ourge  of  India     and  that  the 
incidence  of  the  disease  should  remam  so  high  among  the 
troops  point  to  serious  sanitary  defects  as  y^^'^'^^^^ 
A.  U,  the  prevalence  of  venereal  disease  among  the  soldiers 
_n  admission  of  nearly  600  per  mille  tells  its  o«n  tale 

On  reading  the  journals  and  discussions  one  ge«  the 
impression  that  matters  «e  not  as  they  should  be  m  Inia. 
Thereseems  to  bean  absence  ofproper  standards  o   autho- 
rity     Had  there  been  in  each  presidency  duimg  the  past 
twenty  years  thoroughly  equipped  govermnent  laborator^s 
n  ch^g'  of  able  men,  well  trained  in  modem  methods,  the 
contributions  U>  our  knowledge  of  epidemic  '^-^l 
have  been  epoch-making,  and  at  any  rate  we  shodd  ha^e 
been  spared  the  crudeness  which  is  evident  m  the  work 
(partic^arly  in  that  upon  malaria)  of  some  zealous  but 

badly  trained  men.  „+,:oa 

In  estimating  the  progress  of  medicine  m  the  countries 

comprising  Greater  Britain,  the  future  rather  than  the 

194 


BRITISH  MEDICINE  IN  GREATER  BRITAIN 

present  should  be  in  our  minds.    The  strides  which  have 
been  taken  during  the  past  twenty  years  are   a  strong 
warrant  that  we  have  entered  upon  a  period  of  excep- 
tional development.    When  I  see  v.  hat  has  been  accom- 
plished in  this  city  in  the  short  space  of  time  since  I  left,  I 
can  scarcely  credit  my  eyes :   the  reality  exceeds  the  ut- 
most desire  of  my  dreams.    The  awakening  of  the  pro- 
fession in  the  United  States  to  a  consciousness  of  its  respon- 
sibilities and  opportunities  has  caused  unparalleled  changes, 
which  have  given  an  impetus  to  medical  education  and  to 
higher  lines  of  medical  work  which  has  already  borne  a 
rich  harvest.    Within  two  hundred  years  who  can  say 
where  the  intellectual  centre  of  the  Anglo-Saxon  race  will 
be  ?    The  Mother  Country  herself  has  only  become  an 
intellectual  nation  of  the  first  rank  within  a  period  alto- 
gether too  short  to  justify  a  prediction  that  she  has  reached 
the  zenith.    She  will  probably  reverse  the  history  of  Hellas, 
in  which  the  mental  superiority  was  at  first  with  the  colonies. 
At  the  end  of  the  twentieth  century,  ardent  old-world 
students  may  come  to  this  side  "  as  o'er  a  brook,"  seeking 
inspiration  from  great  masters,  perhaps  in  this  very  city ; 
or  the  current  may  turn  towards  the  schools  of  the  great 
nations  of  the  south.    Under  new  and  previously  unknown 
conditions,  the  Africander,  the  Australian,  or  the  New 
Zealander  may  reach  a  development  before  which  even 
"  the  glory  that  was  Greece  "  may  pale.    Visionary  as  this 
may  appear,  it  is  not  one  whit  more  improbable  to-day 
than  would  have  been  a  prophecy  made  in  1797  that  such  a 
gathering  as  the  present  would  be  possible  within  a  century 
on  the  banks  of  the  St.  Lawrence. 
Meanwliile,  to  the  throbbing  vitality  of  modern  medicine 

195 


II  ii 


I  > 


' « 


'  (, 


BBITISH  MEDICINE  IN  OBEATBE  BRITAIN 
the  t-o  «.t  m«ti««.  1»M  'W  «">»*• '"  ""^  "  "^^ 

,  i^  prid.  in  .  P""-""  "^lit     K-tmctil  of 

„«Ud„..  obUterating  the  rtrong«t  '•"«»' ^™'°"'^'^"7, 

:Ltl    »l^:Ube'x»ohed1    Whoc.„»yt^t 
«.  o«  TUn.  win  weld  n.  link,  "e'""" -"^^t 

!rt;:dCi:^:^:r;:--?^Ht 

o,  hope  at  least  that  the  ^-'-';— ^.^t 

earth  ^^^^^  ^^IZ^o^^rLr^^-  »<  'hat 
gUmmot  perhaps  oi  the  larger  Bop 

day  when  "  the  common  sense  of  most  shaU 
.      ,M  ■  in  awe  "  There  remains  for  us.  Grea       -  awns  oi 
ZlZZi.  the  ho«>den   duty  to  cherish  the  best 
r^dSrof  our  fathe.,and  particularly  of  the  men  who 
"ttBritish  medicine  its  most  distinctive  fea^res.  o 

'"^-^-rrHry^x^itio:: 

Literature.  Science  and  Practice. 

196 


I 


XI 


AFTER  TWENTY-FIVE  YEARS 


197 


;>  I 


:->^^:' 


For  iome  we  loved,  the  loveliest  and  tae  best 
That  from  his  Vintage  rolling  Time  has  prett. 

Have  drunk  their  Cup  a  Round  or  two  before, 
And  one  oy  one  crept  ailently  to  rest. 

Omab  Khayyam. 


196 


tfta^MMiiaHife 


XI 


AFTER  TWENTY-FIVE  YEARS 


FROM  two  points  of  view  alone  have  we  a  wide  and 
satisfactory  view  of  life-one.  as,  amid  the  glorious 
tints  of  the  early  mom.  ere  the  dew  of  youth  ha^  been 
brushed  off.  we  stand  at  the  foot  of  the  hill,  ea^^er  for  the 
journey  ;  the  other,  wider,  perhaps  less  satisfactory,  as  we 
gaze  from  the  summit,  at  the  lengthening  shadows  cast 
the  setting  sun.    From  no  point  in  the  ascent  have  we  the 
same  broad  outlook,  for  f.e  steep  and  broken  pathway  af- 
fords few  halting  places  with  an  unobscured  viewi    You 
remember  in   the  ascent  of  the  Mountain  of  Purgatory. 
Dante,  after  a  difficult  climb,  reached  a  high  terrace  en- 
circUng  the  hill,  and  sitting  down  turned  to  the  East  re- 
marking to  his  conductor-"  all  men  are  dehghted  to  look 
back  "    So  on  this  occasion,  from  the  terrace  of  a  quarter 
of  a  century.  I  am  delighted  to  look  back,  and  to  be  able  to 
tell  you  of  the  prospect. 

Twenty.five  years  ago  this  Faculty,  with  some  hardi- 
hood, selected  a  young  and  untried  man  to  deliver  the  lee 
»  McOill  allege.  Montreal,  1899. 
19C 


I 


AFTER  TWENTY-FIVE  YEABS 

tures  on  the  Institutes  of  Medicine.    With  characteristic 
generosity  the  men  who  had  claims  on  the  position  in  virtue 
of  service  in  the  school,  recognizing  that  the  times  were 
changing,  stepped  aside  m  favour  of  one  who  had  had  the 
advantage  of  post-graduate  traming  in  the  subjects  to  be 
taught.    The  experiment  of  the  Faculty,  supplemented  on 
my  part  by  enthusiasm,  constitutional  energy,  and  a  fond- 
ness for  the  day's  work,  led  to  a  certain  measure  of  success. 
I  have  tried  to  live  over  again  in  memory  those  happy  early 
days,  but  by  no  possible  effort  can  I  recall  much  that  I 
would  fainremember.  The  dust  of  passing  years  has  blurred 
the  details,  even  in  part  the  general  outlines  of  the  picture. 
The  blessed  faculty  of  forgetting  is  variously  displayed  in 
us.    In  some,  as  in  our  distinguished  countryman,  John 
Beattie  Crozier,  it  is  absent  altogether,  and  he  fills  chapter 
after  chapter  with  delightful  reminiscences  and  descriptions 
of  his  experiences  and  mental  states.'     At  corresponding 
periods— we  are  about  the  same  age— my  memory  hovers 
like  a  shade  about  the  magic  circle  which  Ulysses  drew  in 
Hades,  but  finds  no  Tiresias  to  lift  the  veil  with  which  obli- 
vion has  covered  the  past.    Shadowy  as  are  these  recollec- 
tions, which, 

be  they  what  they  may 
Are  yet  the  fountain  light  of  all  our  day, 
Are  yet  a  master  light  of  all  our  seeing, 

they  are  doubly  precious  from  their  association  with  men 
who  welcomed  me  into  the  Faculty,  now,  alas,  a  sadly  re- 
duced remnant.  To  them— to  their  influence,  to  their  ex- 
ample, to  the  kindly  encouragement  I  received  at  their 
hands— I  can  never  be  sufficiently  grateful.    Faithfulness 

*  My  Inner  Life,  Longmans,  1898. 
200 


AFTER   TWENTY-FIVE   YEARS 

in  the  day  of  small  things  may  be  said  to  have  been  the 
distinguishing  feature  of  the  work  of  the  Faculty  in  those 
days.  The  lives  of  the  senior  members  taught  us  youngsters 
the  lesson  of  professional  responsibility,  and  the  whole  tone 
of  the  place  was  stimulating  and  refreshmg.  It  was  an 
education  in  itself,  particularly  in  the  amenities  of  faculty 
and  professional  life,  to  come  under  the  supervision  of  two 
such  Deans  as  Dr.  George  Campbell  and  Dr.  Palmer 
Howard.  How  delightful  it  would  be  to  see  the  chairs  which 
they  adorned  in  the  school  endowed  in  their  memories  and 
called  by  their  names ! 

One  recollection  is  not  at  aU  shadowy— the  contrast  in 
my  feelings  to-day  only  serves  to  sharpen  the  outlines.  My 
first  appearance  before  the  class  filled  me  with  a  tremulous 
mieasiness  and  an  overwhelming  sense  of  embarrassment. 
I  had  never  lectured,  and  the  only  paper  I  had  read  before 
a  society  was  with  all  the  possible  vaso-motor  accompani- 
ment.   With  a  nice  consideration  my  colleagues  did  not 
add  to  my  distress  by  their  presence,  and  once  inside  the 
lecture  room  the  friendly  greeting  of  the  boys  calmed  my 
fluttering  heart,  and,  as  so  often  happens,  the  ordeal  was 
most  severe  in  anticipation.    One  permanent  impression 
of  the  session  abides— the  awful  task  of  the  preparation  of 
about  one  hundred  lectures.    After  the  ten  or  twelve  with 
which  I  started  were  exhausted  I  was  on  the  treadmill  for 
the  remainder  of  the   session.    False   pride   forbade   the 
reading  of  the  excellent  lectures  of  my  predecessor,  Dr< 
Drake,  which,  with  his  wonted  goodness  of  heart,  he  had 
offered.    I  reached  January  in  an  exhausted  condition,  but 
relief  was  at  hand.    One  day  the  post  brought  a  brand-new 
work  on  physiology  by  a  well-known  German  professor 

201 


1 


i  1 1 

i 


AFTER  TWENTY-FIVE  YEARS 

and  it  was  remarkable  with  what  rapidity  my  labours  oi 
the  last  hall  of  the  session  were  lightened.  An  extraordin- 
ary improvement  in  the  lectures  was  noticed  ;  the  students 
benefited,  and  I  gained  rapidly  in  the  facility  with  which  I 
could  translate  from  the  German. 

Long  before  the  session  was  over  I  had  learned  to  appre- 
ciate the  value  of  the  position  entrusted  to  me,  and  sought 
the  means  to  improve  the  methods  of  teaching.    I  had  had 
the  advantage  of  one  of  the  first  systematic  courses  on 
practical  physiology  given  at  University  College,  London, 
a  good  part  of  which  consisted  of  lessons  and  demonstra- 
tions in  histology.    In  the  first  session,  with  but  a  single 
microscope,  I  was  only  able  to  give  the  stock  display  of  the 
circulation  of  the  blood,  ciliary  action,  etc.,  but  a  fortunate 
appointment  as  physician  to  the  smallpox  department  of 
the  General  Hospital  carried  with  it  a  salary  which  enabled 
me  to  order  a  dozen  Hartnack  microscopes  and  a  few  bits 
of  simple  apparatus.     This  is  not  the  only  benefit  I  received 
from  the  old  smallpox  wards,  which  I  remember  with  grati- 
tude, as  from  them  I  wrote  my  first  clinical  papers.    Dur- 
ing the  next  session  I  had  a  series  of  Saturday  demonstra- 
tions, and  gave  a  private  course  in  practical  histology.  One 
grateful  impression    remains  — the  appreciation    by  the 
students  of  these  optional  and  extra  hours;    For  several 
years  I  had  to  work  with  very  scanty  accommodation,  tres- 
passing in    the   chemical   laboratory  in  winter,  and   in 
SUE  iier  using  the  old  cloak  room  downstairs  for  the  histolo- 
gy.   In  1880 1  felt  very  proud  when  the  faculty  converted 
one  of  the  lecture  rooms  into  a  physiological  laboratory  and 
raised  a  fund  to  furnish  and  equip  it.    MeanwhUe  I  had 
found  time  to  take  my  bearings.    From  the  chair  of  the 

202 


I 

1 


AFTER   TWENTY-FIVE   YEARS 

Institutes  of  Medicine  both  physiology  and  pathology  were 
taught.    It  has  been  a  time-honoured  custom  to  devote 
twenty  lectures  of  the  course  to  the  latter,  and  as  my  collea- 
gues at  the  Montreal  General  Hospital  had  placed  the  post- 
mortem room  at  my  disposal  I  soon  found  that  my  chief 
interest  was  in  the  pathological  part  of  the  work.  In  truth, 
I  lacked  the  proper  technique  for  practical  physiology.  For 
me  the  apparatus  never  would  go  right,  and  I  had  not  a 
Diener  who  could  prepare  even  the  simplest  experiments. 
Alas !  there  was  money  expended  (my  own  usuaUy,  I  am 
happy  to  say,  but  sometimes  my  friends',  as  I  was  a  shock- 
ing beggar !)  in  apparatus  that  I  never  could  set  up,  but 
over  which  the  freshmen  firmly  beUeved  that  I  spent  sleep- 
less nights  in  elaborate  researches.  StiU  one  could  always 
get  the  blood  to  circulate,  cUiato  wave  and  the  fibrin  to 
digest.    I  do  not  think  that  any  member  of  the  ten  suc- 
cessive classes  to  which  I  lectured  understood  the  structure 
of  a  lymphatic  gland,  or  of  the  spleen,  or  of  the  placental 
circulation.  To  those  structures  I  have  to-day  an  ingrained 
hatred,  and  I  am  always  delighted  when  a  new  research 
demonstrates  the  folly  of  all  preceding  views  of  their  forma- 
tion.   Upon  no  subjects  had  I  harder  work  to  conceal  my 
ignorance.    I  have  learned  since  to  be  a  better  student,  and 
to  be  ready  to  say  to  my  fellow  students  "  I  do  not  know." 
Four  years  after  my  college  appointment  the  Governors  of 
the  Montreal  General  Hospital  elected  me  on  the  visiting 
staff.    What  better  fortune  could  a  young  man  desire  !  I 
left  the  same  day  for  London  with  my  dear  friend,  George 
Ross,  and  the  happy  days  we  had  together  working  at 
clinical  medicine  did  much  to  weau  me  from  my  first  lovei 
From  that  date  I  paid  more  and  more  attention  to  patho- 

203 


it 


I 


•f  I 


AFTER  TWENTY-FIVE   YEARS 

logy  and  practical  medicine,  and  added  to  my  courses  one 
in  morbid  anatomy,  another  in  pathological  histology,  and 
a  summer  class  in  clinical  medicinei  I  had  become  a  plura- 
list of  the  most  abandoned  sort,  and  at  the  end  of  ten  years 
it  was  difficult  to  say  what  I  did  profess  :  I  felt  like  the  man 
in  Alcibiades  II.  to  whom  are  applied  the  words  of  the 
poet: — 

Full  many  a  thing  he  knew ; 
But  knew  them  all  badly. 

Weakened  in  this  way,  I  could  not  resist  when  temptation 
came  to  pastures  new  in  the  fresh  and  narrower  field  of 
clinical  medicine. 

After  ten  years  of  hard  work  I  left  this  (  rich  man 

not  in  this  world's  goods,  for  such  I  have  th-.     ^fortune — 
or  the  good  fortune — lightly  to  esteem,  but  rich  in  the  goods 
which  neither  rust  nor  moth  have  been  able  to  corrupt, — 
in  treasures  of  friendship  and  good  fellowship,  and  in  those 
treasures  of  widened  experience  and  a  fuller  knowledge  of 
men  and  manners  which  contact  with  the  bright  minds  in 
the  profession  ensures.    My  heart,  or  a  good  bit  of  it  at 
least,  has  stayed  with  those  who  bestowed  on  me  these  trea- 
sures.   Many         y  I  have  felt  it  turn  tov'T,rds  this  city  to 
the  dear  frit         .  left  there,  -v  college  companions,  my 
teachers,  my  old  chums,  the  men  with  whom  I  lived  in 
closest  intimacy,  and  in  parting  from  whom  I  felt  the 
chordse  tendinese  grow  tense. 

II 

Twenty-five  years  ago  the  staff  of  this  school  consisted 
of  the  historic  septenary,  with  one  demonstrator.  To-day 
I  find  on  the  roll  of  the  Faculty  52  teachers.    Nothing  em- 

204 


AFTER    i'WENTY-FIVE   YEARS 

phasizcs  80  sharply  the  character  of  the  revolution  wliich 
has  graduaUy  and  sUently  replaced  in  great  part  for  the 
theoretical,  practical  teaching,  for  the  distant,  cold  lecture 
of  the  amphitheatre  the  elbow  to  elbow  personal  contact 
0*  the  laboratory.  The  school,  as  an  organization,  the 
teacher  and  the  student  have  been  profoundly  influenced 

by  this  change. 

When  I  joined  the  faculty  its  finances  were  in  a  condition 
of  deUghtful  simplicity,  so  simple  indeed  that  a  few  years 
later  they  were  intrusted  to  my  care.    The  current  ex- 
penses were  met  ly  the  matriculation  and  graduation  fees 
and  the  government  grant,  and  each  professor  collected  the 
fees  and  paid  the  expenses  in  his  department.    To-day  the 
support  of  the  laboratories  absorbs  a  much  larger  sum  than 
the  entire  income  of  the  school  in  1874.    The  greatly  in- 
creased accommodation  required  for  the  practical  teaching 
has  made  endowment  a  vital  necessity.    How  nobly,  by 
spontaneous  gifts  and  in  generous  response  to  appeals  the 
citizens  have  aided  the  efforts  of  this  faculty  I  need  not 
remind  you.    Without  it  McGill  could  not  have  kept  pace 
with  the  growing  demands  of  modern  methods.    Upon  one 
feature  in  the  organization  of  a  first-class  school  permit  me 
to  dwell  for  a  moment  or  two.    The  specialization  of  to-day 
means  a  group  of  highly  trained  experts  in  the  scientific 
branches,  men  whose  entire  energies  are  devoted  to  a  single 
subject     To  attain  proficiency  of  this  sort  much  time  and 
money  are  required.    More  than  this,  these  men  are  usually 
drawn  from  our  very  best  students,  with  minds  above  the 
average.    For  a  majoi  Ay  of  them  the  life  devoted  to  science 
is  a  sacrifice  ;  not,  of  course,  that  it  is  so  felt  by  them,  smce 
the  very  essence  of  success  demands  that  in  their  work 

205 


[?;:ii 


i 


■: 


AFTER  TWENTY-FIVE   YEARS 

should  lie  their  happiness.  I  wish  that  the  situation  could 
be  duly  appreciated  by  the  profession  at  large,  and  by  the 
trustees,  governors  and  the  members  of  the  faculties 
throughout  the  country.  Owing  these  men  an  enormous 
debt,  since  we  reap  where  they  have  sown,  and  gamer  the 
fruits  of  their  husbandry,  what  do  we  give  them  in  return  ? 
Too  often  beggarly  salaries  and  an  exacting  routine  of 
teaching  which  saps  all  initiative.  Both  in  the  United 
States  and  Canada  the  professoriate  as  a  class,  the  men  who 
live  by  college  teaching,  is  wretchedly  underpaid.  Only  a 
few  of  the  medical  schools  have  reached  a  financial  position 
which  has  warranted  the  establishment  of  Horoughly 
equipped  laboratories,  and  fewer  still  pay  salanes  in  any 
way  commensurate  with  the  services  rendered.  I  am  fully 
aware  that  with  cobwebs  in  the  purse  not  what  a  faculty 
would  desire  has  only  too  often  to  be  done,  but  I  have  not 
referred  to  the  matter  without  full  knowledge,  as  there  are 
schools  with  large  incomes  in  which  there  has  been  of  late  a 
tendency  to  cut  down  salaries  and  to  fill  vacancies  too  much 
on  Wall  Street  principles.  And  not  for  relief  of  the  pocke^ 
alone  would  I  plead.  The  men  in  charge  of  our  Canadian 
laboratories  are  overworked  in  teaching.  A  well  organized 
staff  of  assistants  is  very  difficult  to  get,  and  still  more  diffi- 
cult to  get  paid.  The  salary  of  the  professor  should  be  in 
many  cases  that  of  the  first  assistant.  When  the  entire 
energy  of  a  laboratory  is  expended  on  instruction,  research, 
a  function  of  equal  importance,  necessarily  suffers.  Special 
endowments  are  needed  to  meet  the  incessant  and  urgent 
calls  of  the  scientific  staff.  It  is  gratifying  to  know  that 
certam  of  the  bequests  to  this  school  have  of  late  been  of 
this  kind,  but  I  can  safely  say  that  no  department  is  as  yet 

206 


AFTER  TWENTY-FIVE   YEARS 

fully  endowed.  Owing  to  faulty  conditions  of  preliminrry 
education  the  medical  school  has  to  meet  certain  illegiti- 
mate expenses.  No  one  should  be  permitted  to  register  as 
a  medical  student  who  ha-l  not  a  good  preliminary  training 
in  chemistry.  lu  is  an  anomaly  that  our  schools  should 
continue  to  teach  general  chemistry,  to  the  great  detriment 
of  the  subject  of  medical  chemistry,  which  alone  belongs  in 
the  curriculum.    Botany  occupies  a  similar  position. 

But  the  laboratories  of  this  medical  school  are  not  those 
directly  under  its  managemt  nt.    McGill  College  turned  out 
good  doctors  when  it  b  d  no  scientific  laboratories,  when 
the  Montreal  General  Hospital  and  the  University  Mater- 
nity were  its  only  practical  departments.    Ample  clinical 
material  and  gO(-<l  methods  of  instruction  gave  the  school 
its  reputation  more  than  fifty  years  ago.    Great  as  has  been 
the  growth  of  the  scientific  half  of  the  school,  the  all-im- 
portant practical    half   has   more   than  kept  pace.    The 
princely  endowment  of  the  Ro>al  Victoria  Hospital  by  our 
large-hearted  Canadian  Peers  has  doubled  the  cUnical  fa- 
culties of  this  school,  and  by  the  stimulus  of  a  healthy 
rivalry  has  put  the  Montreal  General  Hospital  into  a  con- 
dition of  splendid  efficiency.    Among  the  many  changes 
which  have  occurred  within  the  past  twenty-five  years,  I 
would  place  these  first  in  order  of  importance,  since  they 
assure  the  continued  success  of  McGiU  as  a  school  of  practi- 
cal medicine. 

Equally  with  the  school  as  an  organization,  the  teacher 
has  felt  deeply  the  changed  conditions  in  m  al  education, 
and  many  of  us  are  much  embarrassed  know  what  and 
how  to  teach.  In  a  t- :^riod  of  transition  it  is  not  easy  to  get 
orientirt.    In  some  subjects  fortunately  there   is  but  the 

207 


AFTER  TWENTY-FIVE  YEARS 
single  difficulty-what  to  teach.    The  phenomenal  stridea 
in  every  branch  of  scientific  medicine  have  tended  to  over- 
load it  with  detaU.    To  winnow  the  wheat  from  the  chaff 
and  to  prepare  it  in  an  easUy  digested  shape  for  the  tender 
stomachs  of  first  and  second  year  students  taxes  the  re- 
sources of  the  .aost  capable  teacher.    The  devotion  to  a 
subject,  and  the  enthusiasm  and  energy  which  enables  a 
man  to  keep  abreast  wi*1.  its  progress,  are  the  very  qualities 
which  often  lead  him  into  pedagogic  excesses.    To  reach  a 
right  judgment  m  these  matters  is  not  easy,  and  after  all 
it  may  be  said  of  teaching  as  Izaak  Walton  says  of  angling, 
"  Men  are  to  be  born  so,  I  mean  with  inclinations  to  it." 
For  many  it  is  very  hard  to  teach  down  to  the  level  of  be- 
ginners.  The  Rev.  John  Ward,  Vicar  of  Stratford-on-Avon, 
shortly  after  Shakespeare's  day  made  an  uncomplimentary 
classification   of   doctors   which  has  since  become  well- 
known  :— "  first,  those  that  can  talk  but   doe    nothing ; 
secondly,  some  that  can  doe  but  not  talk  ;  third,  some  that 
can  both  doe  and  talk  ;  fourthly,  some  that  can  neither  doe 
nor  talk— and  these  get  most  monie." '  Professors  similarly 
may  be  divided  into  four  classes.    There  is,  first,  the  man 
who  can  think  but  who  has  neither  tongue  nor  technique. 
Though  useless  for  the  ordinary  student,  he  may  be  the 
leaven  of  a  faculty  and  the  chief  glory  of  his  university. 
A  second  variety  is  the  phonographic  professor,  who  can 
talk  but  who  can  neither  think  nor  work.    Under  the  old 
regime  he  repeated  year  by  year  the  same  lecture.    A  third 
is  the  man  who  has  technique  but  who  can  neither  talk  nor 
think ;  and  a  fourth  is  the  rare  professor  who  can  do  all 
»  Diary  of  the  Rev.  John  Ward,  ed.  Dr.  Charles  Severn,  Lond.; 

1839. 

208 


I 


AFTER  TWENTY-FIVE  YEARS 

three— think,  talk  and  work.  With  these  types  fairly  re- 
presented in  a  faculty,  the  diversities  of  gifts  only  serving 
to  illustrate  the  wide  spirit  of  the  teacher,  the  Dean  at  least 
should  feel  happy. 

But  the  problem  of  all  others  which  is  perplexing  the 
teacher  to-day  is  not  so  much  what  to  teach,  but  how  to 
teach  it,  more  especially  how  far  and  in  what  subjects  the 
practical  shall  take  the  place  of  didactic  teaching.    All  wil' 
agree  that  a  large  proportion  of  the  work  of  a  medical  stu- 
dent should  be  in  the  laboratory  and  in  the  hospital.    The 
dispute  is  over  the  old-fashioned  lecture,  which  has  been 
railed  against  in  good  set  terms,  and  which  many  would 
like  to  see  abolished  altogether.    It  is  impossible,  I  think 
to  make  a  fixed  rule,  and  teachers  should  be  allowed  a  wide 
discretion.    With  the  large  classes  of  many  schools  the 
abolition  of  the  didactic  lecture  would  require  a  total  recon- 
struction of  the  curriculum  and   indeed  of   the  faculty. 
Slowly  but  surely  practical  methods  are  everywhere  taking 
the  place  of  theoretical  teaching,  but  there  will,  I  think, 
always  be  room  in  a  school  for  the  di<^    tic  lecture.    It  is 
destined  within  the  next  ten  years  to  be  much  curtailed, 
and  we  shall  probably,  as  is  usual,  go  to  extremes,  but  there 
will  always  be  men  who  can  present  a  subject  in  a  more 
lucid  and  attractive  manner  than  it  can  be  given  in  a  book. 
Sir  William  Gairdner  once  remarked  that  the  reason  why 
the  face  and  voice  of  the  teacher  had  so  much  more  power 
than  a  book  is  that  one  has  a  more  !  ving  faith  in  him. 
Years  ago  Murchison  (than  whom  Gi^at  Britain  certainly 
never  had  a  more  successful  teacher  of  medicine)  limited 
the  lecture  in  medicine  to  the  consideration  of  rare  cases, 
and  the  prominent  features  of  a  group  of  cases,  and  to  ques- 
AE.  209  P 


I 


VFTER  TWENTY-FIVE  YEARS 

tioM  of  prognosi>  which  cannot  be  di«cu«ed  at  the  bedside. 
For  the  past  four  years  m  the  subject  of  medicme  I  have 
been  making  an  experiment  in  teaching  only  by  a  weekly 
examination  on  a  set  topic,  by  practical  work  in  the  wards, 
in  the  out-patient  room  and  the  clinical  laboratory,  and  by 
a  weekly  consideration  in  the  amphitheatre  of  the  acute 
diseases  of  the  season.  With  a  smaU  class  I  have  been 
satisfied  with  the  results,  but  the  plan  would  be  difficult  to 
carry  out  with  a  I'.rge  body  of  students. 

The  student  lives  a  happy  life  in  comparison  with  that 
which  feU  to  our  lot  thirty  years  ago.    Envy,  not  sym- 
pathy, is  my  feeling  towards  him.    Not  only  is  the  rrnnu 
more  attractive,  but  it  is  more  diversified  and  the  viands 
are  better  prepared  and  presented.    The  present  tendency 
to  stuffing  and  cramming  wUl  be  checked  in  part  when  you 
cease  to  mb,  ^he  milk  of  general  chemistry  and  botany  with 
the  proper  dietary  of  the  medical  school.    Undoubtedly 
the  student  tries  to  learn  too  much,  and  we  teachers  try  to 
teach  him  too  much-neither,  perhaps,  with  great  success. 
The  existing  evils  result  from  neglect  on  the  part  of  the 
teacher,  student  and  examiner  of  the  great  fundamental 
principle  laid  down  by  Plato-that  education  is  a  life-long 
process,  In  which  the  student  can  only  makt.  a  beginning 
during 'his  college  course.    The  system  under  which  we 
work  asks  too  much  of  the  student  in  a  limited  time.    To 
cover  the  vast  field  of  medicine  in  four  years  is  an  impos- 
sible task.    We  can  only  instil  principles,  put  the  student 
in  the  right  path,  give  him  methods,  teach  him  how  to 
study,  and  early  to  discern  between  essentials  and  non- 
essentials.   Perfect  happiness  for  student  and  teacher  will 
come  with  the  abolition  of  examinations,  which  are  stum- 

210 


1 


AFTER  TWENTYFIVE  YEARS 

bling  blocks  and  rocks  of  offence  in  the  pathway  of  the  true 
student.    And  it  is  not  so  Utopian  as  may  appear  at  first 
bl-ah.    Ask  any  demonstrator  of  anatomy  ten  days  before 
the  examinations,  and  he  should  be  able  to  give  you  a  list 
of  the  men  fit  to  pass.    Extend  the  personal  intimate  know- 
ledge such  as  is  possessed  by  a  competent  demonstrator  of 
anatomy  into  all  the  other  departments,  and  the  degree 
could  be  safely  conferred  upon  certificates  of  competency, 
which  would  really  mean  a  more  thorough  knowledge  of  a 
man's  fitness  than  can  possibly  be  got  by  our  present  sys- 
tem of  examination.    I  see  no  way  of  avoiding  the  neces- 
sary tests  for  the  license  to  practise  before  the  provincial 
or  state  boards,  but  these  should  be  of  practical  fitness  only, 
and  not,  as  is  now  so  often  the  case,  of  a  man's  knowledge 
of  the  entire  circle  of  the  medical  sciences. 

Ill 

But  what  is  most  important  in  an  introductory  lecture 
remains  to  be  spoken,  for  dead  indeed  would  I  be  to  the  true 
spirit  of  this  day,  were  I  to  deal  only  with  the  questions  of 
the  curriculum  and  say  nothing  to  the  young  men  who  now 
begin  the  serious  work  of  life.  Personally,  I  ha^e  never 
had  any  sympathy  with  the  oft-repeated  sentiment  ex- 
pressed originally  by  Abernethy,  I  believe,  who,  seeing  a 
large  class  of  medical  students,  exclaimed,  "  Good  God, 
gentlemen  !  whatever  will  become  of  you  1 "  The  profes- 
sion into  which  you  enter  to-day  guarantees  to  each  and 
every  one  of  you  a  happy,  contented,  and  useful  life.  I  do 
not  know  of  any  other  of  which  this  can  be  said  with  greater 
assurance.  Many  of  you  have  been  influenced  in  your 
choice  by  the  example  and  friendship  of  the  doctor  iu  your 

211 


Ihi 


.^! 


I 


b^£^ 


AFTER   TWENTY-nVE   YEARS 
Umily,  or  of  some  country  practitioner  in  whom  you  have 
recognized  the  highest  type  o!  manhood  and  whose  unique 
position  in  the  community  has  fiUed  you  with  a  laudable 
ambition.    You  wiU  do  weU  to  make  such  an  one  your  ex- 
cmplar,  and  I  would  urge  you  to  start  with  no  higher  am- 
bition than  to  join  the  noble  band  of  general  practitioners. 
They  form  the  very  sinews  of  the  profession— generous- 
hearted  men,  with  weU-balanced,  cool  heads,  not  scientific 
always,  but  learned  in  the  wisdom  not  of  the  laboratories 
but  of  the  sick  room.    This  school  can  take  a  greater  pride 
in  her  graduates  scattered   throughout    the   length   and 
breadth   of  the  contment  than  in  her   present  splendid 
equipment ;  they  explain  in  great  part  the  secret  of  her 

strength. 

I  was  much  interested  the  other  day  in  reading  a  letter 
of  John  Locke  to  the  Earl  of  Peterborough  who  had  con- 
sulted him  about  the  education  of  his  son.    Locke  Insisted 
that  the  main  point  in  education  is  to  get "  a  relish  of  know- 
ledge."   "  This  is  putting  life  into  a  pupil."    Get  early 
this  relish,  this  clear,  keen  joyance  in  work,  with  which 
languor  disappears  and  aU  shadows  of  annoyance  flee  away. 
But  do  not  get  too  deeply  absorbed  to  the  exclusion  of  aU 
outside  interests.    Success  in  life  depends  as  much  upon  the 
man  as  on  the  physician.    Mix  with  your  fellow  students, 
mingle  with  their  sports  <^nd  their  pleasures.    You  may 
think  the  latter  rash  advice,  but  now-a-days  even  the  plea- 
sures of  a  medical  stude  t  have  become  respectable,  and  I 
have  no  doubt  that  the  "  footing  supper,"  which  in  old 
Cot^  street  days  was  a  Bacchanalian  orgie,  has  become  a 
love  feast  in  which  even  the  Principal  and  the  Dean  might 
participate.    You  are  to  be  members  of  a  poUte  as  weU  as 

212 


mmmmmsS' 


AFTER  TWENTY-FIVE  YEARS 
of  a  liberal  profewion  and  the  more  you  see  of  life  outside 
the  narrow  circle  of  your  work  the  better  equipped  wiU  you 
be  for  the  strugglo.  I  often  wish  that  the  citizens  in  our 
large  educational  centres  would  take  a  little  more  mterest 
in  the  social  life  of  the  students,  many  of  whom  catch  but 
few  glimpses  of  home  life  during  their  course. 

As  to  your  method  of  work.  I  have  a  single  bit  of  advice, 
which  I  give  with  the  earnest  conviction  of  its  paramount 
influence  in  any  success  which  may  have  attended   my 
efforte  in  Ufe-TaJte  no  thought  for  the  morrm.    Live  neither 
in  the  past  nor  in  the  future,  but  let  each  day's  work  absorb 
your  entire  energies,  and  satisfy  your  widei,^.  ambition 
That  was  a  singular  but  very  wise  answer  which  Cron.v- '» 
gave  to  BeUevire— "  No  one  rises  so  high  as  he  who  kiio    i 
not  vhither  he  is  going,"  and  there  is  much  truth  in  it.  The 
student  who  is  worrying  about  his  future,  anxious  over  tlie 
examinations,  doubting  his  fitness  for  the  profession,  is 
certain  not  to  do  so  well  as  the  man  who  cares  for  nothing 
but  the  matter  in  hand,  and  who  knows  not  whither  he  is 

going ! 

While  medicine  is  to  be  your  vocation,  or  calling,  see  to 
it  that  you  have  also  an  avocation— some  intellectual  pas- 
time which  may  serve  to  keep  you  in  touch  with  the  world 
of  art,  of  science,  or  of  letters.    Begin  at  once  the  cultiva- 
tion of  some  interest  other  than  the  purely  professional. 
The  difficulty  is  in  a  selection  and  the  choice  will  be  differ- 
ent according  to  your  tastes  and  training.    No  matter  what 
it  is— but  have  an  outside  hobby.    For  the  hard  working 
medical  student  it  is  perhaps  easiest  to  keep  up  an  interest 
in  literature.    Let  each  subject  in  your  year's  work  have  a 
corresponding  outside  author.    When  tired  of  anatomy 

219 


i 


V 


AFTER   TWENTY-FIVE   YEARS 

refresh  your  mind  with  Oliver  Wendell  Hohnes ;  after  a 
worrying  subject  in  physiology,  turn  to  the  great  idealists, 
to  Shelley  or  Keats  for  consolation ;  when  chemistry  dis- 
tresses your  soul,  seek  peace  in  the  great  pacifier,  Shake- 
speare; and  when  the  complications  of  pharmacology  are 
unbearable,  ten  minutes  with  Montaigne  will  lighten  the 
burden.    To  the  writings  of  one  old  physician  I  can  urge 
your  closest  attention.    There  have  been,  and,  happily, 
there  are  still  in  our  ranks  notable  illustrations  of  the  inti- 
mate relations  between  medicine  and  literature,  but  in  the 
group  of  literary  physicians  Sir  Thomas  Browne  stands 
preeminent.    The  Religio  Medici,  one  of  the  great  English 
classics,  should  be  in  the  hands— in  the  hearts  too— of  every 
medical  student.    As  I  am  on  the  confessional  to-day,  I 
may  tell  you  that  no  book  has  had  so  enduring  an  influence 
on  my  life.     I  was  introduced  to  it  by  my  first  teacher,  the 
Rev.  W.  A.  Johnsou,  Warden  and  Founder  of  the  Trinity 
College  School,  and  I  can  recall  the  delight  with  which  I 
first  read  its  quaint  and  charming  pages.    It  was  one  of  the 
strong  influences  which  turned  ray  thoughts  towards  medi- 
cine as  a  profession,  and  my  most  treasured  copy— the 
second  book  I  ever  bought— has  been  a  constant  companion 
for  thirty-one  years,— comes  viae  vitseque.      Trite  but  true, 
is  the  comment  of  Seneca—"  If  you  are  fond  of  books  you 
will  escape  the  ennui  of  life,  you  will  neither  sigh  for  even- 
ing, disgusted  with  the  occupations  of  the  day— nor  will 
you  live  dissatisfied  with  yourself  or  unprofitable  to  others." 
And,  finally,  every  medical  student  should  remember 
that  his  end  is  not  to  be  made  a  chemist  or  physiologist  or 
anatomist,  but  to  learn  how  to  recognize  and  treat  disease, 
how  to  become  a  practical  physician.    Twenty  years  ago. 

214 


AFTER   TWENTY-FIVE   YEARS 

during  the  summer  session.  I  held  my  first  class  in  clinical 
medicine  at  the  Montreal  General  Hospital,  and  on  the  title 
page  of  a  note  book  I  had  printed  for  the  students  I  placed 
the  foUowing  sentence,  which  you  will  find  the  alpha  and 
omega  of  practical  medicine,  not  that  it  by  any  means 
covers  the  whole  field  of  his  education  :— 

"  The  knowledge  which  a  man  can  use  is  the  only  real 
knowledge,  the  only  knowledge  which  has  life  and  growth 
in  it  and  converts  itself  into  practical  power.  The  rest 
hangs  like  dust  about  the  brain  or  dries  like  rain  drops  off 
the  stones."    (Froude.) 


Hi 


\'n\ 


216 


b 


How  easily,  how  secretly,  how  safely  in  books  do  we  make  bare 
without  shame  the  poverty  of  human  ignorance  !  These  are  the 
masters  that  instruct  us  without  rod  and  ferrule,  without  words 
of  auger,  without  payment  of  money  or  clotuing.  Should  ye 
approach  them,  they  are  not  asleep ;  if  ye  seek  to  question  them, 
they  do  not  hide  themselves ;  should  ye  err,  they  do  not  chide ; 
and  should  ye  show  ignorance,  they  know  not  how  to  laugh.  O 
Books  !  ye  alone  are  free  and  Uberal.  Ye  give  to  all  that  seek,  and 
set  free  all  that  servo  you  zealously. 

RiCHABD  DE  BuEY,  PMhMUon,  Crolier  Oub  Edition,  vol.  ii.  p.  22 

Books  delight  us  when  prosperity  sweetly  smiles ;  they  stay  to 
comfort  us  when  cloudy  fortune  frowns.  They  lend  strength  to 
human  compacts,  and  without  them  grave  judgments  may  not  be 

P'°P°^°^^-  Ibid.  p.  113. 

For  Books  are  not  absolutely  dead  things,  but  do  contain  a 
potency  of  Ufe  In  them  to  be  as  active  as  that  soul  was  whose  progeny 
they  are ;  nay,  they  do  preserve  as  in  a  vial  the  purest  efficacy  and 
extraction  of  that  living  intellect  that  bred  them. 

JoHS  Milton,  Areopagitica. 


218 


^v 


XII 


BOOKS  AND   MEN' 

THOSE  of  us  from  other  citb"  \/ho  bring  congratu- 
lations ^Ms  evening  can  hardly  escape  thetinglings 
of  envy  when  we  see  this  noble  treasure  house  ;  but  in  my 
own  case  the  bitter  waters  of  jealousy  which  rise  in  my 
soul  are  at  once  diverted  by  two  strong  sensations.    In  the 
f  rst  place  I  have  a  feeling  of  lively  gratitude  towards  this 
library.    In   1870  as  a  youngster  interested  in  certain 
clinical  subjects  to  which  I  could  find  no  reference  in  our 
library  at  McGiU,  I  came  to  Boston,  and  I  here  found  what 
I  wanted,  and  I  found  moreover  a  cordial  welcome  and 
many  friends.    It  was  a  small  matter  I  had  in  hand  but  I 
wished  to  make  it  as  complete  as  possible,  and  I  have  al- 
ways felt  that  this  library  helped  me  to  a  good  start.    It 
has  been  such  a  pleasure  in  recurring  visits  to  the  library  to 
find  Dr.  Brigham  in  charge,  with  the  same  kindly  interest 
in  visitors  that  he  showed  a  quarter  of  a  century  ago. 
But  the  feeling  which  absorbs  all  others  is  one  of  deep 
satisfaction  that  our  friend,  Dr.  Chadwick,  has  at  last  seen 
fulfilled  the  desire  of  his  eyes.    To  few  is  given  the  tenacity 
of  will  which  enables  a  man  to  pursue  a  cherished  purpose 
through  a  quarter  of  a  century—"  Ohne  Hast,  aher  ohne 
Raet "  ('tis  his  favourite  quotation) ;  to  fewer  still  is  the 

I  Boeton  Medical  Library.  1901. 
219 


BOOKS  AND  MEN 

fruition  granted.  Too  often  the  reaper  is  not  the  sower. 
Too  often  the  fate  of  those  who  labour  at  some  object  for 
the  public  good  is  to  see  their  work  pass  into  other  hands, 
and  to  have  others  get  the  credit  for  enterprises  which  they 
have  initiated  and  made  possible.  It  has  not  been  so 
with  our  Liend,  and  it  intensifies  a  thousandfold  the  plea- 
sure of  this  occasion  to  feel  the  fitness,  in  every  way,  of  the 
felicitations  which  have  been  offered  to  him. 

It  is  hard  for  me  to  speak  of  the  value  of  libraries  in 
terms  which  would  not  seem  exaggerated.  Books  have 
been  my  delight  these  thirty  years,  and  from  them  I  have 
received  incalculable  benefits.  To  study  the  phenomena 
of  disease  without  books  is  to  sail  an  uncharted  sea,  while 
to  study  books  without  patients  is  not  to  go  to  sea  at  all. 
Only  a  maker  of  books  can  appreciate  the  labours  of  others 
at  their  true  value.  Those  of  us  who  have  brought  forth 
fat  volumes  should  offer  hecatombs  at  these  shrines  of 
Minerva  Medica.  What  exsuccous,  attenuated  offspring 
they  would  have  been  but  for  the  pabulum  furnished 
through  the  placental  circulation  of  a  library.  How 
often  can  it  be  said  of  us  with  truth,  "  Das  heste  was  er  ist 
verdankt  er  Andern  !  " 

For  the  teacher  and  the  worker  a  great  library  such  as 
this  is  indispensable.  They  must  know  the  world's  best 
work  and  know  it  at  once.  They  mint  and  make  current 
coin  the  ore  so  widely  scattered  in  journals,  transactions 
and  monographs.  The  splendid  collections  which  now  exist 
in  five  or  six  of  our  cities  and  the  unique  opportunities  of 
the  Surgeon-General's  Library  have  done  much  to  give 
to  American  medicine  a  thoroughly  eclectic  character. 
But  v'hen  one  considers  the  unending  making  of  books, 

220 


\ 

■  1 

H 

t; 


BOOKS  AND  MEN 
who  does  not  sigh  for  the  happy  days  of  that  thrice  happy 
Sir  WiUiam  Browne'  whose  pocket  library  sufficed  for 
his  Ufe's  needs ;  drawing  from  a  Greek  testament  his  di- 
vinity, from  the  aphorisms  of  Hippocrates  his  medicme, 
and  from  an  Elzevir  Horace  his  good  sense  and  vivacity. 
There  should  be  in  connection  with  every  library  a  corps 
of  instructors  in  the  art  of  reading,  who  would,  as  a  labour 
of  love,  teach  the  young  idea  how  to  read.    An  old  writer 
says  that  there  are  four  sorts  of  readers  :  "  Sponges  which 
attract  all  without  distinguishing ;  Howre-glasses  which 
receive  and  powre  out  as  fast ;  Bagges  which  only  retam 
the  dregges  of  the  spices  and  let  the  wine  escape,  and  Sives 
which  retaine  the  best  onely."    A  man  wastes  a  great 
many  years  before  he  reaches  the  "  sive  "  stage. 

For  the  general  practitioner  a  weU-used  library  is  one  of 
the  few  correctives  of  the  premature  seniUty  which  is  so  apt 
to  overtake  him.    Self-centred,  self-taught,  he  leads  a 
soUtary  life,  and  unless  his  every-day  experience  is  con- 
trolled by  careful  reading  or  by  the  attrition  of  a  medical 
society  it  soon  ceases  to  be  of  the  slightest  value  and  be- 
comes a  mere  accretion  of  isolated  facts,  without  corre- 
lation.   It  is  astonishing  with  how  little  reading  a  doctor 
can  practise  medicine,  but  it  is  nc.  astonishing  how  badly 
he  may  do  it.    Not  three  months  ago  a  physician  living 
within  an  hour's  ride  of  the  Surgeon-General's  Library 
brought  to  me  his  little  girl,  aged  twelve.    The  diagnosis 
of  infantUe  myxoedema  required  only  a  half  glance.    In 

i  In  one  of  the  Annual  Orations  at  the  Royal  CoUege  of  Physicians 
he  said :  "  Behold  an  instaace  of  human  ambition  !  not  to  be  rati- 
fied but  by  the  conquest,  as  it  were,  of  three  worlds,  lucre  m  the 
country,  honour  in  the  coUege,  pleaaure  in  the  medicinal  sprmgs. 

221 


i-' 


n 


I 


II    1 


,  1 


BOOKS  AND  MEN 

placid  contentment  he  had  been  practising  twenty  years 
in  "  Sleepy  Hollow  "  and  not  even  when  his  own  flesh  and 
blood  was  touched  did  he  rouse  from  an  apathy  deep  as 
Rip  Van  Winkle's  sleep.    In  reply  to  questions :  No,  he 
had  never  seen  an3rthing  in  the  journals  about  the  thyroid 
gland ;  he  had  seen  no  pictures  of  cretinism  or  myxosdema  ; 
in  fact  his  mind  was  a  blank  on  the  whole  subject.    He  had 
not  been  a  reader,  he  said,  but  he  was  a  practical  man 
with  very  little  time.    I  could  not  help  thinking  of  John 
Bunyan's  remarks  on  the  elements  of  success  in  the  prac- 
tice of  medicine.    "  Physicians,"  he  says,  "  get  neither 
name  nor  fame  by  the  piicking  of  wheals  or  the  picking 
out  thistles,  or  by  laying  ■^f  plaisters  to  the  scratch  of  a 
pin ;  every  old  woman  can  uo  this.    But  if  they  would 
have  a  name  and  a  fame,  if  they  will  have  it  quickly,  they 
must  do  some  great  and  desperate  cures.    Let  them  fetch 
one  to  life  that  was  dead,  let  them  recover  one  to  his  wits 
that  was  mad,  let  them  make  one  that  was  born  blind 
to  see,  or  let  them  give  ripe  wits  to  a  fool— these  are 
notable  cures,  and  he  that  can  do  thus,  if  he  dost  thus  first, 
he  shall  have  the  name  and  fame  he  deserves  ;  he  may  lie 
abed  till  noon."    Had  my  doctor  friend  been  a  reader  he 
might  have  done  a  great  and  notable  cure  and  even  have 
given  ripe  wits  to  a  tool !    It  is  in  utilizing  the  fresh  know- 
ledge of  the  journals  that  the  young  physician  may  attain 
quickly  to  the  name  and  fame  he  desires. 

There  is  a  third  class  of  men  in  the  profession  to  whom 
books  are  dearer  than  to  teachers  or  practitioners — a  small, 
a  silent  band,  but  in  reality  the  leaven  of  the  whole  lump. 
The  profane  call  them  bibliomaniacs,  and  in  truth  they 
are  at  times  irresponsible  and  do  not  always  know  the 

222 


BOOKS  AND  MEN 

difference  between  meum  and  tuum.    In  the  presence  of 
Dr.  Billings  or  of  Dr.  Chadwick  I  dar-;  not  further  charac- 
terize them.    Loving  books  partly  for  their  contents, 
partly  for  the  sake  of  the  authors,  they  not  alone  keep 
alive  the  sentiment  of  historical  continuity  in  the  pro- 
fession, but  they  are  the  men  who  make  possible  such 
gatherings  as  the  one  we  are  enjoying  this  evening.    We 
need  more  men  of  their  class,  particulariy  in  this  country, 
where  every  one  carries  in  his  pocket  the  tape-measure  of 
utility.    Along  two  lines  their  work  is  valuable.    By  the 
historical  method  alone  can  many  problems  in  medicine  be 
approached  profitably.    For  example,  the  student  who 
dates  his  knowledge  of  tuberculosis  from  Koch  may  have  a 
very  correct,  but  he  has  a  very  incomplete,  appreciation 
of  the  subject.    Within  a  quarter  of  a  century  our  libraries 
will  have  certain  alcoves  devoted  to  the  historical  con- 
sideration of  the  great  diseases,  which  will  give  to  the 
student  that  mental  perspective  which  is  so  valuable  an 
equipment  in  life.    The  past  is  a  good  nurse,  as  Lowell 
remarks,  particularly  for  the  weanlings  of  the  fold. 

'Tis  man's  worst  deod 
To  let  the  things  that  have  been,  run  to  wast© 
And  in  the  unmeaning  Present  sink  the  Past. 

But  in  a  more  excellent  way  these  laudatores  temporis 
acti  render  a  royal  se-vice.  For  each  one  of  U3  to-day,  as 
in  Plato's  time,  there  is  a  higher  as  well  as  a  lower  edu- 
cation. The  very  marrow  and  fitness  of  books  may  not 
suffice  to  save  a  man  from  becoming  a  poor,  mean-spirited 
devil,  without  a  spark  of  fine  professional  feelmg,  and 
without  a  thought  above  the  sordid  issues  of  the  day. 

The  men  I  speak  of  keep  alive  in  us  an  interest  in  the  great 

223 


) 


i 


BOOKS  AND  MEN 

men  of  the  past  and  not  alone  in  their  works,  which  they 
cherish,  but  in  their  lives,  which  they  emulate.  They 
would  remind  us  continually  that  in  the  records  of  no 
other  profession  is  there  to  be  found  so  large  a  number 
of  men  who  have  combined  intellectual  pre-eminence  with 
nobility  of  cha-acter.  This  higher  education  so  much 
needed  to-day  is  not  given  in  the  school,  is  not  to  be  bought 
in  the  market  place,  but  it  has  to  be  wrought  out  in  each 
one  of  us  for  himself ;  it  is  the  silent  influence  of  character 
on  character  and  in  no  way  more  potently  than  in  the 
contemplationof  the  lives  of  the  great  and  good  of  the  past, 
in  no  way  more  than  in  "  the  touch  divine  of  noble  natures 

gone." 

I  should  like  to  see  in  each  library  a  select  company 
of  the  Immortals  set  apart  for  special  adoration.  Each 
country  might  have  its  representatives  in  a  sort  of  alcove 
of  Fame,  in  which  the  great  medical  classics  were  gathered 
Not  necessarily  books,  .^cre  often  the  epoch-making  con- 
tributions to  be  found  in  ephemeral  journals.  It  is  too 
early,  perhaps,  to  make  a  selection  of  American  medical 
classics,  but  it  might  be  worth  while  to  gather  suffrages 
in  regard  to  the  contributions  which  ought  to  be  placed 
upon  our  Roll  of  Honour.  A  few  years  ago  I  made  out  a  list 
of  those  I  thought  the  most  worthy  which  I  carried  down  to 
1850,  and  it  has  a  certain  interest  for  us  this  evening.  The 
native  modesty  of  the  Boston  physician  is  well  known, 
but  in  certain  circles  there  has  been  associated  with  it  a 
curious  psychical  phenomenon,  a  conviction  of  the  utter 
worthlessness  of  the  statw  prmens  ^.  New  England,  as 
compared  with  conditions  existing  elsewhere.  There  is  a 
variety  to-day  of  the  Back  Bay  Brahmin  who  delights 

224 


BOOKS   AND   MEN 


in  cherishing  the  belief  that  medically  things  are  every- 
where better  than  in  Boston,  and  who  is  aiways  ready  to 
predict  "an  Asiatic  removal  of  candlesticks,"  to  borrow 
a  phrase  from  Cotton  Mather.  Strange  indeed  would  it 
have  been  had  not  such  a  plastic  profession  as  ours  felt 
the  influences  which  moulded  New  England  mto  the  in- 
tellectual centre  of  the  New  World.  In  reality,  nowhere 
in  the  country  has  the  profession  been  adorned  more  plen- 
tifully with  men  of  culture  and  of  character— not  volu- 
minous writers  or  exploiters  of  the  prouucts  of  other 
men's  brains— and  they  manage  to  get  a  full  share  on  the 
Roll  of  Fame  which  I  have  suggested.  To  1850,  I  have 
counted  some  twenty  contributions  of  the  first  rank,  con- 
tributions which  for  one  reason  or  another  deserve  to  be 
called  American  medical  classics.  New  England  takes 
ten.  But  ill  medicine  the  men  she  has  given  to  the  other 
parts  of  the  country  have  bf  m  better  than  books.  Men 
like  Nathan  R.  Smith,  Austin  Flint,  Willard  Parker,  Alon- 
zo  Clark,  Elisha  Bartlett,  John  C.  Dalton,  and  others 
carried  away  from  their  New  England  homes  a  love  of 
truth,  a  love  of  lca.rrjnji  and  above  all  a  proper  estimate 
of  the  personal  character  of  the  physician. 

Dr.  Johnson  shrewdly  remarked  that  ambition  was 
usuaUy  proportionate  to  capacity,  which  is  as  true  of  a 
profession  as  it  is  of  a  man.  What  we  have  seen  to-night 
reflects  credit  not  less  on  your  ambition  than  on  your 
capacity.  A  library  after  all  is  a  great  catalyser,  accelera- 
ting the  nutrition  and  rate  of  progress  in  a  profession,  and 
I  am  sure  you  will  find  yourselves  the  better  for  the  sacri- 
fice you  have  made  in  securing  this  home  for  your  books, 
this  workshop  for  your  members. 

AE.  225  Q 


I 


XIII 

MEDICINE  IN  THE  NINETEENTH 
CENTURY 


I 


227 


I  I 

il"'    ^' 
I 


Even  where  the  milder  zone  afforded  man 

A  seeming  shelter,  yet  contagion  there. 

Blighting  his  being  with  unnumbered  ills, 

Spread  hke  a  quenchless  fire ;  nor  truth  availed 

Till  late  to  arrest  its  progress,  or  create 

That  peace  which  first  in  bloodless  victory  waved 

Her  snowy  standard  o'er  this  favoured  clime. 

Happiness 

And  Science  dawn  though  late  upon  the  earth ; 

Peace  cheers  the  mind,  health  renovates  the  frame  ; 

Dibease  and  pleasure  cease  to  mingle  here. 

Reason  and  passion  cease  to  combat  there ; 

Whilst  mind  unfettered  o'er  the  earth  extends 

Its  all-Bubduiug  energies,  and  wields 

The  sceptre  of  a  vast  dominion  there. 

Shelley,  The  Daemon  of  the  Wcrld, 


nb 


xm 

MEDICINE  IN  THE  NINETEENTH 
CENTURY ' 

FOR  countless  generations  the  prophets  and  kings  of 
humanity  have  desired  to  see  the  things  which  men 
have  seen,  and  to  hear  the  things  which  men  have  heard 
in  the  course  of  the  wonderful  nineteenth  century.  To 
the  call  of  the  watchers  on  the  towers  of  progress  there 
had  been  the  one  sad  answer— the  people  sit  in  darkness 
and  in  the  shadow  of  death.  Politically,  socially,  and 
morally  the  race  had  improved,  but  for  the  unit,  for  the 
individual,  there  was  little  hope.  Cold  philosophy  shed 
a  glimmer  of  light  on  his  path,  religion  in  its  various  guises 
illumined  hia  sad  heart,  but  neither  availed  to  lift  the 
curse  of  suffering  from  the  sin-begotten  son  of  Adam.  In 
the  fulness  of  time,  long  expected,  long  delayed,  at  last 
Science  emptied  upon  him  from  the  horn  of  Amalthea 
blessings  which  cannot  be  enumerated,  blessings  which 
have  made  the  century  forever  memorable ;  and  which 
have  followed  each  other  with  a  rapidity  so  bewildering 
that  we  know  not  what  next  to  expect.  To  us  in  the 
medical  profession,  who  deal  with  this  unit,  and  measure 

*  Johns  Hopkins  Historical    Club,   January,  1901 ;    and  pub- 
lished in  the  New  York  Sun 

229 


i'i 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

progress  by  the  law  of  the  greatest  happiness  to  the  greatest 
number,  to  us  whose  work  is  with  the  sick  and  .'ifiering, 
the  great  boon  of  this  wonderful  century,  with  which  no 
other  can  be  compared,  is  the  fact  that  the  leaves  of  the 
tree  of  Science  have  been  for  the  healing  of  the  n  lions. 
Measure  as  we  may  the  progress  of  the  world — materially, 
in  the  advantages  of  steam,  electricity,  and  other  mechani- 
cal appliances ;  sociologically,  in  the  great  improvement 
in  the  conditions  of  life ;  intellectually,  in  the  diffusion 
of  education ;  morally,  in  a  possibly  higher  standard  of 
ethics — there  ia  no  one  measure  which  can  compare  with 
the  decrease  of  physical  suffering  in  man,  woman,  and 
child  when  stricken  by  disease  or  accident.  This  is  the 
one  hct  of  supreme  personal  import  to  every  one  of  U3. 
f  a.    '  the  Promethean  gift  of  the  century  to  man. 

THE  GROWTH  OF  SCIENTIFIC  MEDICINE 

The  century  opened  auspiciously,  and  those  who  were 
awake  saw  signs  of  the  dawn.  The  spirit  of  Science  was 
brooding  on  the  waters.  In  England  the  influence  of 
John  Hunter  stimulated  the  younger  men  to  the  study 
of  the  problems  of  anatomy  and  pathology.  On  the  Con- 
tinent the  great  Boerhaave— the  Batavian  Hippocrates 
— had  taught  correct  ways  in  the  study  of  the  clinical 
aspects  of  disease,  and  the  work  of  Haller  had  given  a 
great  impetus  to  physiology.  The  researches  of  Morgagni 
had,  as  Virchow  has  remarked,  introduced  anatomical 
thinking  into  medicine.  But  theories  still  controlled 
practice.  Under  the  teaching  of  CuUen,  the  old  idea  that 
humours  were  the  seat  of  disease  had  given  place  to  a  neuro- 

230 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
pathology  which  recognized  the  paramount  influence  of 
the  nervous  system  in  disease.    His  coUeague  at  Edin- 
burgh,  Brown,  brought  forward  the  attractive  tlieory  that 
aU  diseases  could  be  divided  into  two  groups,  the  one 
caused  by  excess  of  excitement— the  sthenic— the  other 
by  deficiency-the  asthenic-«ach  having  its  appropriate 
treatment,  the  one  by  depletion,  the  other  by  stimulation. 
In  a  certain  measure  Hahnemann's  theory  of  homoeo- 
pathy was  a  reaction  against  the  prevalent  theories  of 
the  day,  and  has  survived  through  the  century,  though  in 
a  much  modified  form.    Some  of  his  views  were  as  follows : 
"  The  only  vocation  of  the  physician  is  to  heal ;  theo- 
retical knowledge  is  of  no  use.    In  a  case  of  sickness  he 
should  only  know  what  is  curable  and  the  remedies.    Of 
the  diseases  he  cannot  know  anything  except  the  symp- 
toms.   There  are  internal  changes,  but  it  is  impossible 
to  learn  what  they  are ;  symptoms  alone  are  accessibic ; 
with  their  removal  by  remedies  the  disease  is  removed. 
Their  effects  can  be  studied  in  the  healthy  only.    They 
act  on  the  sick  by  causing  a  disease  simUar  to  that  which 
is  to  be  combated,  and  which  dissolves  itself  into  this 
simUar  affection.    The  full  doses  required  to  cause  symp- 
toms in  the  well  are  too  large  to  be  employed  as  remedies 
for  the  sick.    The  healing  power  of  a  drug  grows  in  an 
inverse  proportion  to  its  substance.    He  says,  literally : 
'  Only  potencies  are  homoeopathic  medicines.'    '  I  recog- 
nize nobody  as  my  follower  but  him  who  gives  medicine 
in  so  small  doses  as  to  preclude  the  perception  of  anything 
medicinal  in  them  by  means  either  of  the  senses  or  of 
chemistry.'    'The  pellets  may  be  held  near  the  young 
infant  when  asleep.'    '  Gliding  the  hand  over  the  patient 

231 


i    |1^ 


)  1 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

will  cure  him,  provided  the  manipulation  is  done  with 
firm  intention  to  render  as  much  good  with  it  as  possible, 
for  its  power  is  in  the  benevolent  will  of  the  manipulator.' 
Such  is  the  homoepathy  of  Hahnemann,  which  is  no  longer 
recognized  in  what  they  call  homoeopathy  to-day."— 
(A.  Jacobi.) 

The  awakening  came  in  France.  In  1801  Bichat,  a 
young  man,  published  a  work  on  general  anatomy,  in 
which  he  placed  the  seat  of  disease,  not  in  the  organs,  but 
in  the  tissues  or  fabrics  of  which  ':hey  were  composed, 
which  gave  an  ejctraordinary  impetus  to  the  investigation 
of  pathological  changes.  Meanwhile,  the  study  of  the 
appearances  of  organs  and  bodies  when  diseased  (morbid 
anatomy),  which  had  been  prosecuted  with  vigor  by  Mor- 
gagni  in  the  eighteenth  century,  had  been  carried  on 
actively  in  Great  Britain  and  on  the  Continent,  and  the 
work  of  Broussais  stimulated  a  more  accurate  investiga- 
tion of  local  disorders.  The  discovery  by  Laennec  of  the 
art  of  auscultation,  by  which,  through  changes  in  the 
normal  sounds  within  the  chest,  various  diseases  of  the 
heart  and  limgs  could  be  recognized,  gave  an  immense 
impetus  to  clinical  research.  The  art  of  percussion,  dis- 
covered by  Auenbrugger  in  the  eighteenth  century,  and 
reintroduced  by  Corvisart,  contributed  not  a  little  to  the 
same.  Laennec's  contributions  to  the  study  of  diseases 
of  the  lungs,  of  the  heart,  and  of  the  ab-^ominal  organs 
really  laid  the  foundation  of  modern  clinical  medicine.  A 
little  later  Bright  published  his  researches  on  diseases  of 
the  kidneys,  from  which  we  date  our  knowledge  of  this 
important  subject.  One  of  the  most  complicated  problems 
of  the  first  half  of  the  century  related  to  the  differentiation 

282 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

of  the  fevers.  The  eruptive  fevers,  measles,  scarlet  fever, 
and  small-pox  were  easily  recognized,  and  the  great  group 
of  malarial  fevers  was  well  known ;  but  there  remained 
the  large  class  of  contmued  fevers,  which  had  been  a  source 
of  worry  and  dispute  for  many  generations.  Louis  clearly 
differentiated  typhoid  fever,  and  by  the  work  of  his  Ameri- 
can pupils,  W.  W.  Gerhard  and  Alfred  Still6,  of  Phila- 
delphia, and  George  B.  Shattuck,  of  Boston,  typhus  and 
typhoid  fevers  were  defined  as  separate  and  independent 
affections.  Relapsing  fever,  yellow  fever,  dengue,  etc., 
were  also  distinguished.  The  work  of  Graves  and  Stokes, 
of  Dublin ;  of  Jenner  and  Budd,  in  England ;  of  Drake, 
Dickson,  and  Flint,  in  America,  supplemented  the  labours 
of  the  French  physicians,  and  by  the  year  1860  the  pro- 
fession had  reached  a  sure  and  safe  position  on  the  question 
of  the  clinical  aspects  of  fevers. 

The  most  distinguishing  feature  c  ■  ':he  scientific  medicine 
of  the  century  has  been  the  phenomenal  results  which 
have  followed  experimental  investigations.  While  this 
method  of  research  is  not  new,  since  it  was  introduced  by 
Galen,  perfected  by  Harvey,  and  carried  on  by  Hunter, 
it  was  not  until  well  into  the  middle  of  the  century  that, 
by  the  growth  of  research  laboratories,  the  method  exer- 
cised a  deep  influence  on  progress.  The  lines  of  experi- 
mental research  have  sought  to  determine  the  functions 
of  the  organs  in  health,  the  conditions  under  which  per- 
version ol  these  functions  occurs  in  diseases,  and  the  possi- 
bility of  exercising  protective  and  curative  influences  on 
*;he  processes  of  disease. 

The  researches  of  the  physiological  laboratories  have 
enlarged  in  every  direction  our  knowledge  of  the  great 

233 


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MEDICINE  IN  THE  NINETEENTH  CENTUR'' 

functions  of  life — digestion,  assimilation,  circulation, 
respiration,  and  excretion.  Perhaps  in  no  department 
have  the  results  been  more  surprising  than  in  the  growth 
of  our  knowledge  of  the  frmctions  of  the  brain  and  nerves. 
Not  only  has  experimental  science  given  us  clear  and 
accurate  data  upon  the  localization  of  certain  functions 
of  the  brain  and  of  the  pa'.i  s  of  sensatory  and  of  motor 
impulses,  but  it  has  opened  an  entirely  new  field  in  the 
diagnosis  and  treatment  of  the  diseases  of  these  organs, 
in  certain  directions  of  a  most  practical  nature,  enabling 
us  to  resort  to  measures  of  relief  undreamed  of  even  thirty 
years  ago. 

The  study  of  physiology  and  pathology  withm  the  past 
half-century  has  done  more  to  emancipate  medicine  from 
routine  and  the  thraldom  of  authority  than  all  the  work 
of  all  the  physicians  from  the  days  of  Hippocrates  to 
Jenner,  and  we  are  as  yet  but  on  the  threshold. 

THE    GROWTH   OF  SPECIALISM 

The  restriction  of  the  energies  of  trained  students  to 
narrow  fields  in  science,  while  not  without  its  faults,  has 
been  the  most  important  single  factor  in  the  remarkable 
expansion  of  our  knowledge.  Against  the  disadvantages 
in  a  loss  of  breadth  and  harmony  there  is  the  compensatory 
benefit  of  a  greater  accuracy  in  the  application  of  know- 
ledge in  specialism,  as  is  well  illustrated  in  the  cultivation 
of  special  branches  of  practice.  Diseases  of  the  skin,  of 
the  eye,  of  the  ear,  of  the  throat,  of  the  teeth,  diseases  of 
women,  and  of  children  are  now  studied  and  practised 
by  men  who  devote  all  their  time  to  one  limited  field  of 

234 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

work.  While  not  without  minor  evils,  this  custom  has 
yielded  some  of  the  great  triumphs  of  the  profession. 
Dentistry,  ophthalmology,  and  gynaecology  are  branches 
which  have  been  brought  to  a  state  of  comparative  per- 
fection, and  very  largely  by  the  labours  of  American  physi- 
cians. In  the  last-named  branch  the  blessings  which  have 
been  brought  to  suffering  women  are  incalculable,  not  only 
as  regards  the  minor  ailmeuta  oi  life,  but  in  the  graver  and 
more  critical  accidents  to  which  the  sex  m  liable. 

One  of  the  most  remarkable  and  beneficial  reforms  of 
the  nineteenth  century  has  been  in  the  attitudt  of  the  pro- 
fession and  the  public  to  the  subject  of  insanity,  and  the 
gradual  formation  of  a  body  of  men  in  the  profession  who 
labour  to  find  out  the  cause  and  means  of  relief  of  this  most 
distressing  of  all  human  maladies.    The  reform  movement 
inaugurated  by  Tuke  in  England,  by  Rush  in  the  United 
States,  by  Pinel  and  Eaquirol  in  France,  and  by  Jacobi 
and  Hasse  in  Germany,  has  spread  to  all  civilized  countries, 
and  has  led  not  only  to  an  amelioration  and  improveiuent 
in  the  care  of  the  insane,  but  to  a  scientific  study  of  the 
subject  which  has  already  been  productive  of  much  goodi 
In  this  country,  while  the  treatment  of  the  insane  is  careful 
and  humanitarian,  the  unfortunate  affiliation  of  insanity 
with   politics  is  still   in  many  States  a  serious  hindrance 
to  progress. 

It  may  be  interesting  to  take  a  glance  at  the  state  of 
medicine  in  this  country  at  the  opening  of  the  century. 
There  were  only  three  schools  of  medicine,  the  most  im- 
partant  of  which  were  the  University  of  Pennsylvania  and 
the  Harvard.  There  were  only  two  general  hospitals. 
The  medical  education  was  chiefly  in  the  hands  of  the 

235 


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BOiDICINE  IN  THE  NINETEENTH  CENTURY 

practitioners,  who  took  students  as  apprentices  for  a 
certain  number  of  years.  The  well-to-r'j  students  and 
those  wishing  a  better  class  of  education  went  to  Edin- 
burgh or  London.  There  were  only  two  or  three  medical 
journals,  and  very  few  books  had  been  published  in  the 
country,  and  the  profession  was  dependent  entirely  upon 
translations  from  the  French  and  upon  English  works. 
The  only  medical  libraries  were  in  connexion  with  the 
Pennsylvania  Hospital  and  the  New  York  Hospital.  The 
leading  practitioners  in  the  early  years  were  Rush  and 
Physick,  in  Philadelphia ;  Hosack  and  Mitchill,  in  New 
York ;  and  James  Jackson  and  John  Collins  Warren,  in 
Boston.  There  were  throughout  the  country,  in  smaller 
places,  men  of  great  capabilities  and  energy,  such  as  Nathan 
Smith,  the  founder  of  the  Medical  Schools  of  Dartmouth 
and  of  Yale,  and  Daniel  Drake  in  Cincinnati.  After  1830 
a  remarkable  change  took  place  in  the  profession,  owing 
to  the  leaven  of  French  science  brought  back  from  Paris 
by  American  students.  Between  1840  and  1870  there 
was  a  great  increase  in  the  number  of  medical  schools,  but 
the  general  standard  of  education  was  low — lower,  indeed, 
than  had  ever  before  been  reached  in  the  medical  profes- 
sion. The  private  schools  multiplied  rapidly,  diplomas 
were  given  on  short  two-year  sessions,  ,.-^d  nothing  con- 
tributed more  to  the  degeneration  of  the  profession  than 
this  competition  and  rivalry  between  ill-equipped  medical 
schools.  The  reformation,  which  started  at  Harvard 
shortly  after  1870,  spread  over  the  entire  country,  and 
the  rapid  evolution  of  the  medical  school  has  been  one  of 
the  most  striking  phenomena  in  the  history  of  medicine  in 
the  century.    University  authorities  began  to  apprecia+« 

286 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
the  fact  that  medicine  was  a  great  department  of  know- 
ledge, to  be  cultivated  as  a  science  and  promoted  as  an 
art.  Wealthy  men  lelt  that  in  no  better  way  could  they 
contribute  to  the  progress  of  the  race  than  by  the  estab- 
lishment of  laboratories  for  the  study  of  disease  and  hospi- 
tals for  the  care  of  the  sick  poor.  The  benefactions  of 
Johns  Hopkins,  of  Sims,  -f  Vanderbilt,  of  Pierpont  Morgan, 
of  Strathcona,  of  Mount-Stephen,  of  Payne,  and  of  Levi 
C.  Lane  and  others  have  placed  scientific  medicine  on  a 
firm  basis. 


THE  GROWTH  OF  PREVENTIVE  MEDICINE 

Sanitary  science,  hygiene,  or  preventive  medicine  may 
claim  to  be  one  of  the  brightest  spots  in  the  history  of  the 
nineteenth  century.    Public  hygiene  was  cultivated  among 
the  Egyptians,  and  in  the  Mosaic  law  it  reached  a  remark- 
able organization.    The  personal  hygiene  of  the  Greeks 
was  embraced  in  the  saying,  "  The  fair  mind  in  the  fair 
body,"  and  the  value  of  exercise  and  training  was  fully 
recognized.    The   Romans,   too,   in  public  and   private 
hygiene,  were  our  superiors  in  the  matter  of  water  supply 
and  baths.    But  modern  sanitary  science  has  a  much 
wider  scope  and  is  concerned  with  the  causes  of  disease 
quite  as  much  as  with  the  conditions  under  which  these 
diseases  prevail.    Th     foundations  of  the  science  were 
laid  in  the  last  century  with  Jenner's  discovery  of  vaccina- 
tion.   Howard,  too,  had  grasped  the  association  of  fever 
with  overcrowding  in  the  jails,  while  the  possibility  of  the 
prevention  of  scurvy  had  been  shown  by  Captain  Cook 

and  by  Sir  Gilbert  Blane. 

287 


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BIEDICINE  IN  THE  NINETEENTH  CENTURY 
Preventive  medicine  was  a  blundering,  incomplete 
science  until  bacteriology  opened  unheard-of  possibilities 
for  the  prevention  of  disease.  Before  discussing  some  of 
the  victories  of  preventive  medicme  it  will  be  well  to  take 
a  brief  survey  of  the  growth  of  the  following  subject : 

SaENCE  OF  BACTERIOLOGY 

From  the  brilliant  overthrow  by  Pasteur,  in  1861,  and 
by  Koch  and  Cohn,  in  1876,  of  the  theory  of  spontaneous 
generation,  we  may  date  its  modern  growth.  Wrapped 
up  in  this  theory  of  spontaneous  generation,  upon  which 
speculation  raged  centuries  before  the  invention  of  the 
microscope,  Ues  the  history  of  bacteriology. 

The  ancient  Greek  and  Roman  philosophers  wrestled 
with  the  question,  and  very  interesting  views  of  the  rela- 
tion of  germ  life  to  disease  are  preserved  to  us  in  their 
manuscripts.    With  the  invention  of  the  miscroscope  we 
can  mark  the  first  positive  step  towards  the  goal  of  to-day. 
A  Jesuit  priest,  Kirchcr,  in  1671,  was  the  first  to  investi- 
gate putrefying  meat,  milk,  and  cheese  with  the  crude 
microscope  of  his  day,  and  left  us  indefinite  remarks  con- 
cerning "  very  minute  living  worms  "  found  therein.  Four 
years  after  Kircher  a  Dutch  linen  merchant,  Antonius  von 
Leeuwenhoek,  by  improving  the  lenses  of  the  microscope, 
saw  in  rain-water,  putrefying  fluids,  intestinal  contents, 
and  saliva,  minute,  moving,  living  particles,  which  he 
called  "  animalculsB."    In  medical  circles  of  his  day  these 
observations  aroused  the  keenest  interest,  and  the  theory 
that  these  "  animalculse  "  might  be  the  cause  of  all  disease 
was  eagerly  discussed.    Plenciz,  of  Vicntia,  after  much 
observation  of  various  fluids,  putrefjdng  and  otherwise, 

238 


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BIEDICINE  IN  THE  NINETEENTH  CENTURY 

wrote  m  1762  that  it  was  his  firm  belief  that  the  pheno* 
mena  of  diseases  and  the  decomposition  of  animal  fluids 
were  wholly  caused  by  these  minute  living  things. 

Notwithstanding  such  assertions,  from  his  day  on  until 
Pasteur,  Koch,  and  Cohn  finally  proved  its  misconceptions 
in  1876,  the  theory  of  spontaneous  generation  held  the 
upper  hand  in  all  discussions  upon  the  question. 

The  stimulus  to  research  as  to  the  causes  of  disease 
along  the  line  of  bacterial  origin  did  not  entirely  cease  to 
be  felt,  and  the  names  of  PoUender  and  Davaine  are  linked 
together  in  the  first  undoubted  discovery  of  micro-organ- 
isms m  disease,  when  the  cause  of  anthrax,  a  disease  of 
cattle,  was  solved  in  1863.  Following  closely  upon  Da- 
vame's  researches,  the  primary  causes  of  wound  infection 
were  worked  out,  and  to  the  efforts  of  the  British  surgeon 
Lister  are  due  the  great  advances  of  modern  surgery. 

In  rapid  succession  the  presence  of  bacteria  was  clearly 
demonstrated  in  relapsing  fever,  leprosy,  and  typhoid 
fever ;  but  far  eclipsing  all  former  discoveries,  on  account 
of  the  magnitude  of  the  difficulties  encountered  and  over- 
come, were  the  brilliant  demonstrations  of  the  cause  of 
consumption  and  allied  diseases,  and  that  of  Asiatic  cholera, 
by  Dr.  Robert  Koch  in  1882  and  in  1884  respectively. 

From  that  time  onward  innumerable  workers  have 
satisfied  the  critical  scientific  world  as  to  the  causes  of 
pneumonia,  diphtheria,  tetanus,  influenza,  and  bubonic 
plague,  besides  many  diseases  of  cattle,  horses,  sheep,  and 
other  animals  and  insects. 

Having  glanced  hastily  at  the  history  of  bacteriology, 
we  may  next  consider  some  facts  concerning  the  germs 
themsclvf38.    What  are  they  ?    To  the  lay  mind  the  words 

239 


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MEDiaNE  IN  THE  NINETEENTH  CENTURY 

germ,  microbe  bacterium,  and  bacill  often  -onvey  con- 
fined ideas  oj  invisible,  wri^  gling  orm-li  o  creatures, 
enemies  of  mankind,  e\  ^r  on  the  watcli  to  gu  •>  a  stealthy 
entrince  into  jur  bodies,  whvre  they  wreak  harm  and 
death.  Scientif  cally  considered,  however,  they  are  the 
smallest  of  living  thiiigs  yet  known.  They  are  not  animals, 
but  are  members  of  the  vegetable  kingdom,  and  are  pos- 
sessed of  definite  v^^t  varying  shapes.  They  consist  of  a 
jelly-lik<^  substance  called  protoplasm,  which  is  covereu 
in  and  held  in  place  by  a  well-fo  med  membrane  of  i  rela 
tively  hard  aid  dense  character,  exactly  similar  i  com- 
position to  the  woody  fibre  of  tret 

According  to  their  siiUi  th'>  '  Acteria  are  divide<  .to 
three  chief  groups,  called  respectively  co.  -i,  be  i,  an< 
spirilla.  The  cocci  are  spherical  bodies  aad  r.^y  exist 
singly  o"  in  pair=!.  in  fours,  in  dusterf.  or  i  c  jnp  in 
this  group  we  find  the  smallest  bacteria  kn  v  .  many  of 
them  not  over  -150,000  of  an  inch  diaineter.  The 
bacilli  are  rod  iike  bodi  s,  varymg  miKh  ii  -n?'-  in  « afferent 
species  and  in  members  uf  the  sam*  sp^ie?.  Iney  are 
larger  than  the  cocci,  measiiring  in  length  fe  »  1  25,000 
of  an  inch  to  1-4,000,  a;  I  in  breadth  ir  m  i-i  26,000  to 
1-16,000  of  an  inch,    iiany   varieties  ^^ssed  of 

organs  of  I  comotion  <  alle<l  flagelia 

The  spirilla  resemble  the  bacilli,  except  that  they  are 
twisted  into  corkscrew  shapes,  or  have  gently  undulating 
outlines.  Upon  an  average  they  are  much  longer  than 
tiie  bacilli,  o  e  sp«^'  ^es  being  very  ivxs  neasuring  about 
1-600  of  an  inch.  As  seen  in  the  iiatural  state  bacteria 
are  found  to  be  c«.  .ourleas,  but  it  is  by  the  application  of 
various  aniline  dyes  that  they  are  usually  studied.    These 

240 


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MEDiaNE  IN  THE  NINETEENTH  CENTURY 

minute  plants  increase  hv  a  simple  method  oi  division 
into  two  equal  parts,  or  by  a  more  complex  process  of 
orming  a  seed- -the  so-called  spore— which  later  on  de- 
elope  into  the  lult  form.  Under  fa%-ourable  con  iitions 
they  are  able  t  multiply  at  <*a  enormous  rate;  for  in- 
stance, it  has  been  calculated  that  a  bacillus,  dividing  once 
every  hour  would  at  tht  end  of  tw.^nty-four  hours  have 
i  released  to  seventeen  milliou  ,  and  if  the  division  con- 
'  lied  at  the  s;  me  rat^  we  should  find  at  the  end  of  the 
third  day  rm  incalculc  o  number  of  billions,  whose  weight 
would  be      arly  seven  thoasand  five  hundred  tons! 

But,  fortunately  for  our  welfare,  nature  by  various 
means  rend-  rs  the  possibility  of  such  a  .appening  entirely 
beyond  the  slightest  chance  oi  realization,  her  greatest 
barrier  being  the  lack  of  an  adequate  food  supply. 

The  distribution  in  nature  of  bacteria  is  well-nigh  uni- 
versal. occuTT  2  as  they  do  in  the  air  we  breathe,  the 
water  and  mUk  we  drink,  upon  the  exposed  si 
man  and  animals,  and  in  ^  ^'"'^     '' 

the  soil  to  a  depth  of  abo 
noted  that  at  very  high 

exist,  while  in  the  Arctic  ree  trom  L  r 

their  numbers  are  very  fev 

The  condition^   govern         ae.    j.   jw^  ^vc  maay 

complex  problems,  bu  a  i  w  o  *he  chief  ,  or?  co^  ^r  .e<i 
are  moisture,  lir,  food,  tempe  ture,  tnd  ligut  Ail  bac- 
teria mus^  iiave  moisture,  else  th«  "^  die  soone  or  v  r, 
the  perioc  of  survival  dependin|i  pon  the  hardness  of 
the  species,  and  none  can  niultiph  \vit  .  >ut  it.  A  supp  >' 
of  air  is  by  no  means  easential  to  a  germs.  To  ome  it  ia 
absolutely  necessary,  and  suck  geiiiis  are  called  aerobes. 

AE.  241  B 


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MEDICINE  IN  THE  NINETEENTH  CENTURY 
To  others  air  is  whoUy  detrimental,  and  they  constitute 
the  anaerobes,  while  to  the  majority  of  bacteria  air  supply 
is  a  matter  of  indifierence,  and  in  consequence  they  are 
grouped  under  the  term  facultative  anaerobes. 

The  food  supply  of  mi:uy  consists  of  dead  animal  and 
vegetable  materials,  a  few  require  Uving  tissues,  whUe  a 
smaU  number  can  exist  whoUy  upon  n.lneral  salts,  or  even 
the  nitrogen  of  the  air.    The  lowest  temperature  at  which 
some  bacteria  can  multiply  is  the  freezing-point  of  water, 
and  the  highest  170  degrees  Fahrenheit.    However,  the 
average  range  of  temperature  suitable  to  the  majority  Ues 
between  60  and  104  degrees  Fahrenheit,  98  2-5  degrees 
Fahrenheit  being  the  mo^it  suitable  for  the  growth  of 
disease-producing  germs.    Light,  ordinarUy  diffused  day- 
light, or  its  absence,  is  a  matter  of  no  moment  to  most 
germs,  but  direct  sunUght  is  a  destroyer  of  all  bacteria. 

The  study  of  the  life  histories  of  these  diminutive  plants 
excites  the  wonder  of  those  who  make  observations  upon 
them.    It  is  truly  marvellous  to  know  that  these  bacteria 
can  accomplish  in  their  short  lives  of  possibly  a  few  hours 
or  days  feats  which  would  baffle  the  cleverest  of  chemists 
if  given  years  of  a  lifetime  to  work  upon.    They  give  to 
the  farmer  the  good  quality  of  his  crops,  to  the  dairyman 
superior  butter  and  cheese ;  they  assist  in  large  measure 
in  freeing  our  rivers  and  lakes  from  harmful  poUutions. 
Here  it  should  be  strongly  emphasized  that  those  bacteria 
which  cause  disease  are  only  of  a  few  species,  all  others  con- 
tributing to  our  welfare  in  countless  ways. 

Quite  as  astonishing  b  the  discovery  that  within  the 
root-knobs  of  pease  and  beans  Uve  bacteria  which  by 
splitting  up  mineral  salts  containing  nitrogen,  and  by 

242 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

absorbing  nitrogen  from  the  air,  give  it  over  to  the  plant 
80  that  it  b  ei-Abled  to  grow  luxuriantly,  whereas,  with- 
out theb  presence,  the  tiller  of  the  soU  might  fertilize  the 
ground  in  vain.  It  is  quite  possible  that  not  alone  pease 
and  beans,  but  all  grasses  and  plants  and  trees  depend 
upon  the  presence  of  such  germs  for  their  very  existence, 
which  in  turn  supply  man  and  animals  with  their  means 
of  existence.  Hence  we  see  that  these  nitrifying  bacteria, 
as  they  are  called,  if  swept  out  of  existence.,  would  be  the 
cause  of  cessation  of  all  life  upon  the  globe.  And  arguing 
backward,  one  prominent  authority  states  it  as  his  belief 
that  the  first  of  aU  life  on  this  earth  were  those  lowly  forms 
of  plants  which  only  required  the  nitrogen  of  air  or  salts 
to  enable  them  to  multiply. 

Limiting  observation  now  to  the  sphere  of  medicine, 
it  will  be  readily  perceived  that  the  presence  of  bacterial 
life  in  a  causative  relation  to  disease  b  an  object  of  para- 
mount regard.  The  following  paragraphs  will  briefly  treat 
of  the  diseases  associated  with  micro-crganisms  and  the 
common  modes  of  infection  in  each,  the  chain  of  eventi 
subsequent  to  an  infection,  and  the  possibilities  of  protec- 
tion or  cure  by  means  of  substances  elaborated  in  the  body 
of  an  invidiual  or  animal  recently  recovered  from  an  in- 
fectious disease : 

Anthrax.— A.  disease  chiefly  of  cattle  and  sheep,  occa- 
sionally of  man,  is  caused  by  the  Bacillus  arUhracis,  dis- 
covered m  1849-50  by  Pollender  and  Davaine.  It  enters 
the  body  through  abrasions  of  the  skin,  by  inhalation  of 
the  spores,  or  seeds,  into  the  lungs,  or  by  swallowing  in- 
fected material. 

Leprosy.— TUa  disease  is  caused  by  a  bacillus  Known 


!      .' 


i 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
as  BacShu  leprae,  which  was  discovered  by  Hansen  in 
1879.  It  is  doubtful  if  it  has  been  grown  outside  the  body. 
It  is  supposed  to  enter  by  abrasions  of  the  skin,  but  it  is  very 
feebly  contagious,  notwithstanding  popular  ideas  as  to  its 
supposedly  highly  contagious  nature. 

Tuberculosis.— AXi  forms  of  this  disease,  among  which  is 
ordinary  consumption,  are  caused  by  a  baciUus  closely 
resembling  that  of  leprosy.  It  was  discovered  by  Koch  m 
1880-82,  and  named  BadUus  tuberculosis.  The  ways  of 
infection  are  by  inhalmg  the  dried  sputum  of  consumptives, 
drinking  infected  cow's  milk,  or  eating  infected  meat. 

Typhoid  Fever.— A.  disease  of  human  beings  only.  Eberth 
in  1880  discovered  the  germ  causing  it  and  called  it  BaciUus 
typhosus.  It  gains  entrance  to  our  bodies  chiefly  in  the 
milk  and  water  we  drink,  which  comes  from  infected 
sources ;  a  rarer  method  is  by  inhalation  of  infected  air. 

Diphtheria.— X  disease  of  human  beings  chiefly.    It  is 
caused  by  a  bacUlus  which  was  described  in  1883-84  by 
Klebs  and  Loeffler,  and  is  known  ac  BaciUus  dipJUheriae, 
or  Klebs-Loeffler  bacillus.    Its  moc^.c  of  entry  b  by  inhaUng 
infected  air,  or  by  drinking  or  eating  infected  mUk  or  food. 
C/iofero.— This  disease  is  peculiar  to  human  beings.    Its 
native  home  is  on  the  banks  of  the  river  Ganges  in  India, 
where  Koch  in  1884  was  able  to  isolate  its  causative  spi- 
rillum.   Man  is  infected  by  drinking  contaminated  water 

or  by  contact. 

Lockjaw,  or  TefantM.— Afflicts  men,  horses,  and  dogs. 
The  BaciUus  tetani  is  the  most  deadly  of  all  known  bacteria. 
It  enters  the  body  by  wounds.    It  was  discovered  in  1884 

by  Nicolaier. 
Influenza,  or  the  GWp.-Caused  by  one  of  the  smaUest- 

244 


Jk 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
known  baciUi ;  discovered  in  im  by  Canon  and  Pieiffer. 
Infection  spreads  by  the  scattering  about  by  a^-currents 
of  the  dried  nasal  and  bronchial  secretion  of  those  suffer- 
ing from  the  disease,  and  its  portal  of  entry  is  by  the  nc. 
and  bronchial  tubes.  . 

Pneumoma.-Caused  by  a  coccus  which  grows  m  pa« 
and  smaU  chains.  It  enters  the  body  by  means  of  the 
respiratory  tract.  It  is  present  in  the  saliva  of  twenty  per 
Tenrofhlalthy  persons.    Proved  by  Frankel  in  1886  to  be 

the  cause  of  this  disease.  .    ,  .„j 

Bubonk  Plague.-ln  1894  Kitasato  and  Yersm  isolated 
a  smaU  bacillus  in  a  large  number  of  cases  and  proved  it  to 
be  the  cause.  It  enters  the  body  by  means  of  womids  of 
the  skin,  and  through  bites  of  fleas  from  infected  rats, 
which  are  ..id  to  be  one  of  the  chief  factors  m  spreadmg 

this  dread  malady.  . 

YeUow  Fever.-The  cause  of  this  disease  is  still  under 

discussion.  ^  „.« 

Such  are  a  few  of  the  infectious  diseases  which  we  can 
readily  attribute  to  the  presence  of  definite  micro-organ- 
isms in  respective  cases.    But  strange  as  it  may  seem,  the 
most  typical  of  all  infectious  dUeases.  small-pox.  scarlet 
fever,  measles,  and  hydrophobia,  have  as  yet  not  yielded 
up  their  secrets.    This  is  possibly  due  to  the  minute  size 
of  the  micro-organisms  concerned,  which  make  it  beyond 
the  power  of  the  best  microscope  to  demonstrate  them.    In 
this  coMiexion  it  has  recently  been  shown  by  Roux  and 
Nocard  that  in  the  case  of  the  disease  known  as  pleuro- 
pneumonia of  cattle  the  causative  agent  is  so  vc^  sro..! 
as  just  to  be  barelv  visible.    Agam.  it  is  qnite  po.'ubi^ 
that  these  diseases  may  be  caused  by  living  things  wc  know 

246 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
nothing  about,  which  may  be  quite  dissimilar  from  the 
bacteria. 


INFECTION-ITS  PROCESSES  AND  RESULTS 

In  the  foregoing  list  of  diseases  associated  with  specific 
bacteria,  attention  has  been  arawn  to  the  common  modes 
of  infection,  or,  as  they  are  technically  called,  "  portals 
of  entry,"  and  it  now  remains  to  touch  upon  the  main 
factors,  processes,  and  results  following  upon  the  entry 
into  the  body  of  such  disease-producing  microbes. 

It  is  a  well-known  fact  that  the  normal  blood  has  of 
itself  to  a  considerable  extent  the  power  of  killing  germs 
which  may  wander  into  it  through  various  channels. 
Likewise  the  tissue  cells  of  the  body  m  general  show  similar 
action  depending  upon  the  different  cell  groups,  state  of 
health,  general  robustness,  and  period  of  life.  The  germ- 
killing  power  varies  in  different  individuals,  though  each 
may  be  quite  healthy.  Considered  as  a  whole,  this  power 
possessed  by  the  body  against  germs  is  known  as  "  general 
resistance."  And  when  by  any  means  this  power  of 
resistance  is  lost  or  diminished,  we  run  grave  risks  of 
incurring  disease. 

Granted  a  case  of  infection,  let  us  now  trace  up  briefly 
what  occm*s.  Between  the  period  when  the  bacteria  gain 
a  lodgment  and  that  in  which  the  disease  assumes  a  notice- 
able form,  the  patient  simply  feek  out  of  sorts.  It  is 
during  this  stage  that  the  blood  and  tissues  are  deeply 
engaged  in  the  attempt  to  repel  the  attacks  of  the  invading 
microbes. 
With  varjring  speed  the  germs  multiply  throughout  the 

846 


S' 


MEDICINE  IN  THE  NINETEENTH  CENTTOT   , 
body  neneiaUy,  or  may  be  .t  fart  locriiMd,  oi  even  m  in 

Mdtiplying  in  the  tiMuee,  they  generate  m  me  «»mg 
lo^ito  fteir  nonons  poison.,  which  soon  c»u«  prolo,md 
eh««».  throughout  the  body,  the  patient  b«om«i  de- 

Doi  the  body  now  give  up  the  fight  enti«ly  ?    No , 
on  the  eontrary,  the  white  blood^ella,  the  wandermg  cdK 
°^d  the  eells  o!  the  tissues  mos*  aflected  shB  eay  on  an 
*neq«I  figbt.    From  the  lymphatic  glands  and  spleen 
°^roI  white  cells  rush  to  the  fray  and  .tten.pt  U,  eat 
rind  dertroy  the  toe,  but  possibly  in  vain  •,  the  d^ease 
™ns  its  course,  to  end  either  in  death  or  recove^ 
How,  then,  in  cases  ol  recovery,  are  the  microbes  finaUy 

overcome  ?  i.j_v. 

This  quertion  involves  many  complex  processes  wUch 
at  present  are  by  no  mean,  thoroughly  understood,  but 
we  win  concern  ourselves  with  the  simple  prmciple. 

It  has  been  previously  mentioned  that  once  the  bacteria 
get  a  good  foothold  the  body  is  subjected  to  *»  «" »"  ° 

'generated  PO*"™'  """"  '"  "^"^  "  ''T,  le  fevlr 
L  to  such  symptoms  as  loss  of  appehte,  headache,  feve  , 

^ins  and  ach^  and  even  a  state  of  stupor  or  uncon^m^- 
„eM     In  addition  to  the  active  warfare  of  the  white  blood- 
Za>  groups  of  celU  throughout  the  body,  after  recovenng 
torn  fhe  Lt  rude  shock  of  the  to«ns,  begm  to  toeraU 
S  prepuce,  then  efiect  a  change  in  the  chem.c.^  con- 
Lion  of  the  toxins,  and  finaUy  elaborate  suWUno» 
which  antagonize  the  toxin,  and  destroy  h«r  «t.on  dto- 
gether,  thus  lending  aid  to  the  wamor  cells,  which  at  last 
rvercome  the  invading  microbes.    Recovery  »  brought 

247 


M 


, 


MEDICINE.  IN  THE  NINETEENTH  CENTURY 

about,  and  a  more  or  leas  permanent  degree  of  immunity 
against  the  special  form  of  disease  ensues. 

Now  if  we  could  use  these  antagonizing  substances,  or, 
as  they  are  called,  antitoxins,  upon  other  men  or  animals 
sick  with  a  similar  disease,  would  their  bodies  be  at  once 
strengthened  to  resist  and  finally  overcome  the  disease  1 
Yes,  in  a  certain  majority  of  cases  they  would,  and  this  b 
exactly  what  scientific  observers  have  noted,  worked  out, 
and  have  successfully  applied.  A  new  art  in  the  healing 
of  disease,  which  is  spoken  of  broadly  as  serum-therapy, 
or  medication  by  curative  or  protective  serums,  has  thus 
been  discovered. 

The  first  observers  in  this  new  field  were  Pasteur  and 
Raynaud  in  France  in  1877-78,  and  Salmon  and  Smith  in 
this  country  in  1886.  Raynaud,  by  injecting  serum  from 
a  calf  which  had  had  an  attack  of  cow-pox,  prevented  the 
appearance  of  the  disease  in  a  calf  freshly  inoculated  with 
the  virulent  material  of  the  disease.  Pasteur,  by  using 
feebly  infective  germs  of  fowl  cholera,  conferred  immunity 
upon  healthy  fowls  against  the  disease,  and  was  able  to 
cure  those  which  were  ill.  Salmon  and  Smith  injected 
small  and  repeated  amounts  of  the  elaborated  toxins  or 
poisons  of  the  bacillus  of  hog  cholera  into  healthy  swine, 
and  were  able  to  confer  immunity  upon  them. 

However,  it  was  not  until  Behring  in  1892  announced 
his  discovery  of  an  antitoxin  serum  for  diphtheria,  along 
with  an  undisputed  proof  of  its  value  in  treatment,  that 
the  attention  of  the  scientific  world  was  finally  aroused 
and  stimulated  to  the  appreciation  of  the  great  possibilities 
of  serum-therapy. 

Strange  as  it  may  seem,  much  opposition  arose  to  this 

248 


BIEDICINE  IN  THE  NINETEENTH  CENTURY 

new  method  of  treatment,  not  alone  from  the  lay  portions 
of  the  community,  but  even  from  the  ranks  of  the  medical 
profession  itself.  This  opposition  was  due  in  part  to  mis- 
conceptions of  the  principles  involved  in  the  new  doctrine, 
and  in  part  to  the  falsely  philanthropic  prejudices  of  the 
pseudo-scientific  sections  of  both  parties.  But  by  the 
persevering  work  of  the  enthusiastic  believers  in  serum- 
therapy,  positive  conviction  has  now  replaced  misconcep- 
tion and  prejudice  in  the  minds  of  the  majority  of  its 
former  opponents. 

The  accumulation  of  statistical  evidence,  even  where  all 
allowance  is  made  for  doubtful  methods  of  compilation, 
shows  that  the  aggregate  mortality  of  diphtheria  has  been 
reduced  fully  fifty  per  cent,  since  the  introduction  of  anti- 
toxic treatment  by  Behring  in  1892. 

Since  the  method  of  preparation  of  the  commercial 
diphtheria  antitoxin  illustrates  the  general  principles 
involved  in  the  search  for  the  production  of  curative  or 
protective  serums  for  infectious  diseases  in  general,  a  sum- 
mary of  the  steps  in  its  manufacture  will  now  be  given. 

A  race  of  diphtheria  bacilli,  which  has  been  found  to 
yield  a  poison  of  great  virulence  in  alkaline  beef  broth,  is 
grown  for  a  week  or  ten  days  in  this  medium.  The  toxin 
is  then  separated  and  its  virulence  exactly  determined.  It 
is  preserved  in  sterile  receptacles  for  immediate  or  future 
use.  The  next  step  is  the  inoculation  of  a  suitable  animal 
with  the  toxin.  Of  all  animak  the  horse  has  been  found 
to  meet  nearly  every  requirement.  Such  an  animal,  in  a 
state  of  perfect  health,  receives  an  injection  of  twenty 
cubic  centimetres  of  toxin,  along  with  ten  or  fifteen  of 
standard  antitoxin,  beneath  the  skin  of  the  neck  or  fore- 

249 


i  m 

u- 


Ui 


:/  1 


i? 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

quarters,  upon  three  separate  occasions  at  intervals  of  five 
days.  After  this  it  receives  increasing  doses  of  toxin, 
alone,  at  intervals  of  six  to  eight  days,  until,  at  the  end  of 
two  months,  it  is  able  to  stand  with  Uttle  discomfort  doses 
of  such  strength  that  if  given  in  the  first  stage  these  doses 
would  have  quickly  caused  death. 

At  this  period  the  horse  is  bled  to  a  small  extent,  and 
its  serum  tested  to  ascertain  if  prospects  are  good  for  the 
production  by  the  animal  of  a  high  grade  of  antitoxin.  If 
satisfactory  progress  has  been  made,  the  injections  are 
continued  for  another  month,  when,  as  a  rule,  the  maximal 
degree  of  antitoxic  power  in  the  serum  will  have  been 

attained. 

The  horse  is  now  bled  to  the  proper  extent,  the  blood 
being  received  in  a  sterile  jar  and  placed  in  an  ice-box. 
Here  it  coagulates,  and  the  serum  separates  from  it.  When 
the  separation  of  clot  and  serum  is  complete,  the  latter  is 
drawn  off,  taken  to  the  laboratory,  and  standardized. 
This  being  finished,  an  antiseptic  fluid  is  added  to  pre- 
serve the  serum  from  decomposition.  It  is  then  bottled, 
labelled,  and  sent  out  for  use. 

In  similar  fashion  tetanus  antitoxin  is  prepared ;  and 
quite  recently  Calmette  has  produced  an  antitoxic  serum 
for  use  in  snake  bite,  by  injecting  horses  with  minute  in- 
creasing doses  of  snake  venom.  His  experiments  have 
givf^n  some  remarkable  results,  not  only  in  laboratory 
work,  but  also  in  cases  of  actual  snake  bite  occurring  in 
man.  Thus  bacteriological  scientists,  after  years  of  labori- 
ous work,  in  the  face  of  much  criticism  and  severe  denun- 
ciation, may  confidently  announce  that  they  have  in  their 
possession  a  magic  key  to  one  of  nature's  secret  doors, 

260 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
The  lock  lias  been  turned.    The  door  stands  partly  open, 
and  we  are  permitted  a  glimpse  of  the  future  poasibiUtiea 
to  be  attained  in  the  great  fight  against  disease. 

PREVENTIVE  MEDICINE 

The  following  are  some  of  the  diseases  which  have  been 
remarkably  controlled  through  preventive  medicine  : 

Smofl-pox.— WhUe  not  a  scourge  of  the  first  rank,  like 
the  plague  or  cholera,  at  the  outset  of  the  nineteenth  cen- 
tury  variola  was  one  of  the  most  prevalent  and  dreaded  of 
all  diseases.    Few  reached  adult  life  without  an  attack. 
To-day,  though  outbreaks  still  occur,  it  is  a  disease  tho- 
roughly controlled  by  vaccination.    The  protective  power 
of  the  inoculated  cow-pox  is  not  a  fixed  and  constant 
quantity.    The  protection  may  be  for  life,  or  it  may  last 
only  for  a  year  or  two.    The  all-important  fact  is  this : 
That  efficiently  vaccinated  persons  may  be  exposed  with 
impunity,  and  among  large  bodies  of  men  (e.g.,  the  Ger- 
man army),  in  which  revaccination  is  practised,  small-pox 
is  unknown.    Of  one  hundred  vaccinated  persons  exposed 
to  small-pox,  possibly  one  might  take  the  disease  in  a  mild 
form;  of  one  hundred  unvaccinated  persons  so  exposed 
one  alone  might  escape-from  twenty-five  to  thirty  would 
die     To  be  efficient,  vaccination  must  be  earned  out 
systematically,  and  if  all  the  inhabitants  of  this  country 
were  revaccinated  at  intervals  small-pox  would  disappear 
(as  it  has  from  the  German  army),  and  the  necessity  for 
vaccination  would  cease.    The  difficulty  arises  from  the 
constant  presence  of  an  unvaccinated  remnant,  by  which 
the  disease  is  kept  alive.    The  Montreal  experience  m  1885 
is  an  object-lesson  never  to  be  forgotten. 

251 


ii: 


( 


\  'ir 


1m 

j 


< 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
For  eight  or  ten  yean  vaccination  had  been  neglected, 
particularly  among  th*-  French-Canadians.  On  February 
28, 1886,  a  Pullman  cai  conductor,  who  came  from  Chicago, 
where  the  disease  had  been  slightly  prevalent,  was  ad- 
mitted into  the  H6tel  Dieu.  Isolation  was  not  carried 
out,  and  on  the  1st  of  April  a  servant  in  the  hospital  died 
of  small-pox.  FoUowing  her  death  the  authorities  of  the 
hospital  sent  to  their  homes  all  patients  who  presented  no 
symptoms  of  the  disease.  Like  fire  in  dry  grass,  the  con- 
tagion spread,  and  within  nine  months  there  died  of  small- 
pox three  thousand  one  hundred  and  sixty-four  persons. 
It  ruined  the  trade  of  the  city  for  the  winter,  and  cost 
miUions  of  dollars.  There  are  no  reasonable  objections 
to  vaccination,  which  is  a  simple  process,  by  which  a  mild 
and  harmless  disease  is  introduced.  The  use  of  the  animal 
vaccme  does  away  with  the  possibUity  of  introduction  of 
other  disorders,  such  as  syphilis. 

Typhus  fever.— Until  the  middle  of  the  nineteenth  cen- 
tury this  disease  prevailed  widely  in  most  of  the  large 
cities,  particularly  in  Europe,  and  also  in  jails,  ships, 
hospitals  and  camps.    It  was  more  widely  spread  than 
typhoid  fever  and  much  more  fatal.    Murchison  remarks 
of  it  that  a  complete  history  of  its  ravages  would  be  the 
history  of  Europe  during  the  past  three  centuries  and  a 
half.    Not  one  of  the  acute  infections  seems  to  have  been 
more  dependent  upon  fUth  and  unsanitary  conditions. 
With  the  gradual  introduction  of  drainage  and  a  good 
water  supply,  and  the  reUef  of  overcrowding,  the  disease 
has  almost  entirely  disappeared,  and  is  rarely  mentioned 
now  in  the  bills  of  mortality,  except  in  a  few  of  the  larger 
and  more  unsanitary  cities.    The  foUowing  figures  iUus- 

252 


'  u 


^ 


MEDiaNE  IN  THE  NINETEENTH  CENTURY 

trate  what  has  been  done  in  England  within  sixty  yean  : 
In  1838  in  England  twelve  hundred  and  twenty-eight  per- 
sons died  of  fever  (typhus  and  typhoid)  per  milUon  of 
living.  Twenty  years  Uter  the  Bgures  were  reduced  to 
nine  hundred  and  eighteen  ;  in  1878  to  three  hundred  and 
six  of  typhoid  and  to  thLHy-six  of  typhus  fever.  In  1892 
only  one  hundred  and  thirty-seven  died  of  typhoid  fever 
and  only  three  of  typhus  per  miUion  living '. 

Typhoid  Fet-cr.— While  preventive  medicine  can  claim 
a  great  victory  in  this  disease  also,  it  is  less  brilliant,  since 
the  conditions  which  favour  its  prevalence  are  not  those 
speciaUy  relating  to  overcrowding  as  much  as  to  imperfect 
water  supply  and  the  contamination  of  certam  essential 
foods,  as  milk.    It  has  been  repeatedly  demonstrated  that, 
with  a  pure  water  supply  and  perfect  drainage,  typhoid 
fever  almost  disappears  from  a  city.    In  Vienna,  after  the 
introduction  of  good  water,  the  rate  of  mortality  from 
typhoid  fever  fell  from  twelve  per  ten  thousand  of  the 
inhabitants  to  about  one.    In  Munich  the  faU  was  stUl 
more  remarkable ;  from  above  twentynine  per  ten  thou- 
sand inhabitants  in  1857  it  feU  to  about  one  per  ten  thou- 
sand  in  1887.    That  typhoid  fever  in  this  country  is  still 
a  very  prevalent  disease  depends  mainly  upon  two  facts  : 
First,  not  onlvis  the  typhoid  baciUus  very  resistant,  but  it 
may  remain  for  a  long  time  in  the  body  of  a  person  after 
recovery  from  typhoid  fever,  and  such  persons,  m  apparent 
good  health,  may  be  a  source  of  contamination.    With 
manyof  theconditions  favouring  the  persistence  and  growth 
of  the  bacillus  outside  the  body  we  ate  not  yet  familiar. 
The  experience  in  the  Spanish-American  War  illustrates 
how  dangerous  is  the  concentration  together  of  large 

263 


■    1 


)  ! 


L^'lt 


MEDICINE  IN  IHE  NINETEENTH  CENTURY 
numbew  of  individuals.  But,  ir<ondly,  the  .aaentiai 
factor  in  the  widespread  prevalenio  .f  ty]>hoid  fever  iu 
the  United  States,  particularly  in  countr-  dbin  la,  ia 
the  absence  of  anything  like  efiBcient  nir.i  sanitation. 
Many  countries  have  yet  to  lej^rn  the  alpha l)ft  of  Siuuta- 
tion.  The  chief  danger  results  from  the  impure  water 
supplies  of  the  smaller  towns,  while  the  local  house  epi- 
demics are  due  to  infected  wells,  and  the  mUk  outbreaks 
due  to  the  infection  of  dairy  farms. 

The  importance  of  scrupulously  guardi.g  the  sources  of 
supply  was  never  better  illustrated  than  in  the  well-known 
and  oft-quoted  epidemic  in  Plymouth,  Pennsylvania.  The 
town,  with  a  population  of  eight  thouaan  i,  was  in  part 
supplied  with  drinking-water  from  a  reservoir  fed  by  a 
mountain-stream.    During  January,  February,  and  March, 
in  a  cottage  by  the  side  of  and  at  a  distance  of  from  sixty 
to  eighty  feet  from  this  stream,  a  man  was  ill  with  typhoid 
fever.    The  a.^tendant8  were  in  the  habit  at  night  of  throw- 
ing out  the  evacuations  on  the  ground  towards  the  stream. 
During  these  month    the  ground  was  frozen  and  covered 
with  snow.    In  the  latter  part  of  March  and  early  in  April 
there  was  con:iderable  rainfall  and  a  thaw,  in  which  a 
large  part  of  the  three  months'  accumulation  of  discharges 
was  washed  into  the  brook  no^   Ixty  feet  distant.    At  the 
very  time  of    this  thaw  the  patient  had  numerous  and 
copious  discharges.     About  the  10th  of   April   cases  of 
typhoid  fever  broke  out  in  the  town,  appearing  for  a  time 
at  the  rate  of  fifty  a  day.    In  all  about  twelve  hundred 
were  attacked.    An  imiuense  majority  of  the  cases  were  m 
the  part  of  the  town  which  received  water  from  the  infected 

reservoir. 

254 


MEDICINE  IN  THE  NINETEENTH  Ji^TUBY 
The  use  oi  boiled  water  and  o(  ice  made  fr-  n  distilled 
wat'-r,  the  syatematic  inspection  oi  dairiea,  -  scr  i>ulous 
supervimoii  of  the  sources  from  which  the  ater  is  obtained, 
an  efficient  system  of  sewage  removal,  and,  above  all.  the 
most  scrupulous  care  m  tho  part  of  physicians  and  ot 
nurses  in  the  disinfection  of  the  discharges  of  typhoid  fever 
patients— these  are  the  factors  necessary  to  redufle  to  a 
minimum  the  incidence  of  typhoid  fever. 

Choltrn— One  of  the  great  scourgea  of  the  nineteenth 
CO.-    V     ^adc  inroads  into  Europe  and  America  from 
Inci  .*.  its  native  home.    We  have,  however,  found  out 
the  germ,  found  out  the  conditions  under  which  it  lives, 
and  it  is  not  likely  that  it  will  ever  again  gain  a  foothold 
in  this  country  or  Great  Britain.    Since  the  last  epidemic, 
1873,  the  disease,  though  brought  to  this  country  on  several 
occasions,  has  always  been  held  in  check  at  the  port  of 
entry.    It  is  communicated  almost  entirely  through  in- 
fected water,  and  the  virulence  of  an  epidemic  in  any  city 
is  in  direct  proportion  to  the  imperfection  of  the  water 
supply.    This  was  shown  in  a  remarkable  way  in  the 
Hamburg  epideiric  of  1892.    In  Altona,  which  had  a  filtra- 
tion plant,  there  were  only  five  hundred  and  sixteen  cases, 
many  of  them  refuge'    trom  Hamburg.    Hamburg,  where 
the  unfiltered  water  o.  tlic  Elbe  was  used,  had  some  eighteen 
thousand  cases,  with  nearly  eight  thousand  deaths. 

Yellow  Fi-ver.—Thc  cause  of  this  disease  is  still  under 
discussion.  It  has  an  interest  to  us  in  this  country  from 
its  continued  prevalence  in  Cuba,  and  from  th?  fact  that  at 
intervals  it  makes  inroads  into  the  Southern  States,  causing 
serious  commercial  loss.  The  history  of  the  disease  in  the 
other  West  India  islands,  particularly  Jamaica,  indicates 

256 


1 1  t 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
the  steps  which  must  be  taken  ior  ito  prevention.    For- 
merly  yeUow  fever  was  as  fatal  a  scourge  in  them  as  it  is 
to-day  in  Cuba.    By  an  efficient  system  of  sanitation  it 
has  been  aboUshed.    The  same  can  be  done  (and  wiU  be 
done)  m  Cuba  within  a  few  years.    General  Wood  has 
already  pointed  out  the  way  in  the  cleansing  of  Santiago. 
The  Plagm.-One  of  the  most  remarkable  facts  in 
connexion  with  modern  epidemics  has  been  the  revival 
of  the  bubonic  plague,  the  most  dreaded  of  all  the  great 
infections.    During  the  nineteenth  century  the  disease  m 
Europe  has  been  confined  almost  exclusively  to  Turkey 
and  Southern  Europe.     Since   1894.  when  it  appeared 
at  Hong  Kong,  it  has  gradually  spread,  and  there  have 
been  outbreaks  of  terrible  severity  in  India.    It  has  ex- 
tended to  certain  of  the  Mediterranean  ports,  and  during 
the  past  summer  it  reached  Glasgow,  where  there  has 
been  a  smaU  outbreak.    On  this  hemisphere  there  have 
been  small  outbreaks  in  certain  of  the  South  American 
ports,  cases  have  been  brought  to  New  York,  and  there 
have  been  to  November  1  twenty-one  cases  among  the 
Chmese  in  San  Francisco;     Judging  from  the  readmess 
with  which  it  has  been  checked  and  limited  in  Australia, 
and  ui  particular  the  facility  with  which  the  recent  out- 
break in  Glasgow  has  been  stamped  out.  there  is  very 
little  risk  that  plague  will  ever  assume  the  proportions 
which  gave  to  it  its  terrible  reputation  as  the  "  black 
death"  of  the  Middle  Ages.    As  I  have  already  men- 
tioned, the  germ  is  known,  and  prophylactic  inoculations 
have  been  made  o.i  a  large  scale  in  India,  with  a  certam 
measure  of  success. 

Tuberculosis.— In   all    communities    the    white    plague, 

25G 


MEDiaNE  IN  THE  NINETEENTH  CENTURY 
as  Oliver  WendeU  Holmes  calls  it,  takes  the  first  i-ank 
as  a  killing  disease.  It  has  been  estimated  that  of  it 
one  hundred  and  twenty  thousand  people  die  yearly  in 
this  country.  In  all  mortaUty  biUs  tuberculosis  of  the 
lungs,  or  consumption,  heads  the  list,  and  when  to  this 
ifl  added  tuberculosis  of  the  other  organs,  the  number 
swells  to  such  an  extent  that  this  disease  equals  in  fatality 
all  the  other  acute  infective  diseases  combined,  if  we 
leave  ou^.  pneumonia.  Less  than  twenty  years  ago  we 
knew  little  or  nothing  of  the  cause  of  the  disease.  It 
was  believed  to  be  largely  hereditary.  Koch  discovered 
the  germ,  and  wiih  this  have  come  the  possibiUties  of 
limiting  its  ravages. 

The  foUowing  points  with  reference  to  it  may  be  stated  : 
In  a  few  very  rare  instances  the  disease  is  transmitted 
from  parent  to  chUd.    In  a  large  proportion  of  aU  cases 
the  disease  Ls   "caught."     The   germs  are  widely  dis- 
tributed through  the  sputum,  which,  when  dry,  becomes 
dust,  and  is  blown  about  in  aU  directions.    Tubercle 
baciUi  have  been  found  in  the  dust  of  streets,  houses, 
hospital  wards,  and  much-frequented  places.    A  single 
individual  may  discharge  from  the  lungs  countless  myriads 
of  germs  in   the  twenty-four  hours.    Dr.  NuttaU  esti- 
muted  from  a  patient  in  the  Johns  Hopkins  Hospital, 
who  had  only  moderately  advanced  consumption,  that 
from  one  and  a  half  to  four  and  a  third  bUlions  of  germs 
were  thrown  off  in  the  twenty-four  hours.    The  con- 
sumptive, as  has  been  well  stated,  is  almost  harmless, 
and   only  becomes  harmful   through  bad   habits.    The 
germs  are  contained  in  the  sputum,  which,  when  dry, 
is  widely  scattered  in  the  form  of  dust,  and  constitutes 
AB.  267  8 


1 

'I 


V 


l\ 


BiEDICINE  IN  THE  NINETEENTH  CENTURY 
the  great  medium  for  the  tranBmission  oi  the  difleasc. 
If  expectorated  into  a  handkerchief,  the  sputum  dnes 
quickly,  particularly  if  it  is  put  into  the  pocket  or  under 
the  pi  ow.    The  beard  or  moustache  of  a  consumptive  is 
smeared  with  the  germs.    Even  in  the  most  careful  the 
hands  are  apt  to  be  soUed  with  the  germs,  and  m  those 
who  are  dirty  and  careless  the  furniture  and  matenals 
which    they    handle    readUy    become    infected.    Where 
the   dirty   habit   prevails   of   spitting    on   the   floor,    a 
room    or  the   entire   house,   may   contain   numbers   of 
germ^     In  the  majority  of  all  cases  the  infection  m 
tuberculosis   is   by   inhalation.    This   is    shown    by  the 
frcquencv  with  which  the  disease  is  met  in  the  lungs, 
and  the' great  prevalence  of  tuberculosis  in  institutions 
in  which  the  residents  are  restricted  in  the  matter  of 
fresh  air  and  a   free,   open  life.    The  disease   prevails 
speciaUy  in  cloUters.  in  jails  and  in  asylums.     Infection 
through  mUk  is  also  possible ;    it  is  doubtful  whether 
the  disease  is  transmitted  through  meat.    So  widespread 
are  the  germs  that  post-mortem  examination  has  shown 
that  a  very  large  number  of  persons  show  slight  signs 
of  the  disease  who  have  never  during  life  presented  any 
symptoms;    in  fact,   some  recent   investigations  would 
indicate  that  a  very  large  proportion  of  all  persons  at 
the  age  of  forty  have  somewhere  in  their  belies  slight 
tuberculous  lesions.    This  shows  the  iraportanct   of  the 
individual  predisposition,  upon  which  the  older  writers 
laid  so  much  stress,  and  the  importance  of  maintaimng 
the  nutrition  at  its  maximum. 

One  of  the  most  remarkable  features  of  modern  pro- 
tective medicine  is  the  widespread  interest  that  has  been 

268 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

aroused  in  the  crusade  against  tuberculosis.  What  has 
already  been  accomplished  wanants  the  belief  that  the 
hopes  of  even  the  most  enthusiastic  may  be  realized.  A 
positive  decline  in  the  prevalence  of  the  disease  has  been 
shown  in  many  of  the  larger  cities  during  the  past  ten 
years.  In  Massachusetts,  which  has  been  a  hot-bed  of 
tuberculosis  for  many  years,  the  death-rate  has  fallen 
from  forty- two  per  ten  thousand  inhabitants  in  1863  to 
twenty-one  and  eight-tenths  per  ten  thousand  inhabitants 
m  1895.  In  the  city  of  Glasgow,  in  which  the  records 
have  been  very  carefully  kept,  there  has  been  an  extra- 
ordinary fall  in  the  death-rate  from  tuberculosis,  and  the 
recent  statistics  of  New  York  City  show,  too,  a  similar 
remarkable  diminution. 

In  fighting  the  disease  our  chief  weapons  are :  First, 
education  of  the  public,  particularly  of  the  poorer  classes, 
who  do  not  fully  appreciate  the  chief  danger  in  tlie  disease. 
Secondly,  the  compulsory  notification  and  registration 
of  all  cases  of  tuberculosis.  The  importance  of  this 
relates  chiefly  to  the  very  poor  and  improvident,  from  whom 
after  all,  comes  the  greatest  danger,  and  who  should  be 
under  constant  surveillance  in  order  that  these  dangers 
may  be  reduced  to  a  minimum.  Thirdly,  the  foundation 
in  suitable  localities  by  the  city  and  by  the  State  of 
sanatoria  for  the  treatment  of  early  cases  of  the  disease. 
Fourthly,  provision  for  the  chronic,  incurable  cases  in 
special  hospitals. 

Diphtheria.— Since  the  discovery  of  the  germ  of  this 
disease  and  our  knowledge  of  the  conditions  of  its  trans- 
mission, and  the  discovery  of  the  antitoxin,  there  has 
been  a  great  reduction  in  its  prevalence  and  an  equally 

259 


i 


m 


In 


,1! 


;il 


I  ill 


li* 


MEDICINE  LN  THE  NINETEENTH  CENTURY 
remarkable  reduction  in  the  mortality.    The  more  careful 
isoUtion  of  the  sick,  the  thorough  disinfection  of  the 
clothing,  the  rigid  scrutiny  of  the  nulder  cases  of  throat 
disorder,  a  more  stringent  surveillance  in  the  period  of 
convalescence,  and  the  routine  examination  of  the  throats 
of    school-children-these    are    the    essential    measures 
by  which  the  prevalence  of  the  disease  has  been  very 
markedly  diminished.    The  great  danger  is  in  the  mild 
cases,  in  which  the  disease  has  perhaps  not  been  suspected, 
and  in  which  the  chUd  may  be  walking  about  and  even 
going  to  school.    Such  patients  are  often  a  source  of 
widespread   infection.    The   careful   attention   given   by 
mothers  to  teeth  and  mouth  of  children  is  also  an  important 
factor.    In  children  with  recurring  attacks  of  tonsilUtis, 
in  whom  the  tonsils  are  enlarged,  the  organs  should  be 
removed.    Through  these  measures  the  incidence  of  the 
disease  has  been  very  greatly  reduced. 

Pw«imonto.-WhUe    there    has    been    a    remarkable 
diminution  in  the  prevalence  of  a  large  number  of  aU  the 
acute  infections,  one  disease  not  only  holds  its  own,  but 
seems  even  to  have  increased  in  its  virulence.    In  the 
mortality  bills,  pneumonia  is  an  easy  second,  to  tuber- 
culosis; indeed,  in  many  cities  the  death-rate  is  now  higher 
and  it  has  become,  to  use  the  phrase  of  Bunyan,  "the 
Captain  of  the  men  of  doath."    It  attacks  particularly 
the  intemperate,  the  feeble,  and  the  old,  though  every  year 
a  large  number  of  robust,  bealthy  individuals  succumb. 
So  frequent  is  pneumonia  at  advanced  periods  of  life  that 
to  die  of  it  has  been  said  to  be  the  natural  end  of  old  men 
in  thi6  country.    In  many  ways,  too,  it  is  a  satisfactory 
disease,  if  one  may  use  such  an  expression.    It  is  not 

260 


■■■ 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
associated  with  much  pain,  except  at  the  onset,  the  battle 
is  brief  and  short,  and  a  great  many  old  persons  succumb 
to  it  easily  and  peacefully. 

We  know  the  cause  of  the  disease ;  we  know  only  too 
well  its  symptoms,  but  the  enormous  fatality  (from  twenty 
to  twenty.five  per  cent.)  speaks  only  too  plainly  of  the 
futility  of  our  means  of  cure,  and  yet  in  no  disease  has 
there  been  so  great  a  revolution  in  treatment.  The 
patient  is  no  longer  drenched  to  death  with  drugs,  or 
bled  to  a  point  where  the  resisting  powers  of  nature  are 
exhausted.  We  are  not  without  hope,  too,  that  ux  the 
future  an  antidote  maybe  found  to  the  toxins  of  thedisease, 
and  of  late  there  have  been  introduced  several  measures  of 
great  value  in  supporting  the  weakness  of  the  heart,  a 
special  danger  in  the  old  and  debilitated. 

ffj/dropfto5io.— Rabies,    a   remarkable,   and   in   certain 
countries  a  widespread,  disease  of  animab,  when  trans- 
mitted to  a  man  by  the  bite  of  rabid  dogs,  wolves,  etc.; 
is  known  as  hydrophobia.    The  specific  germ  is  unknown, 
but  by  a  series  of  brilliant  observations  Pasteur  showed 
(1)  that  the  poison  has  certain  fixed  and  peculiar  properties 
in  connexion  with  the  nervous  system  ;  (2)  that  susceptible 
animals  could  be  rendered  refractory  to  the  disea^,  or 
incapable  of  taking  it,  by  a  certain  method  of  inoculation  ; 
and  (3)  that  an  animal  unprotected  and  inoculated  with 
a  dose  of  the  virus  sufficient  to  cause  the  disease  may,  by 
the    injection    of    proper    anti-rabic    treatment    escape. 
Supported  by  these  facts,  Pasteur  began  a  system  of  treat- 
ment of  hydrophobia  in  man,  and  a  special  institute  was 
founded  in  Paris   for  the   purpose.    When   carried  out 
promptly   the    treatment    ia   successful    in   an   immense 

261 


If, 


iw 


i  ^ 


1/  < 


M 


11 


li' 


Ml 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
majority  of  aU  cases,  and  the  mortaUty  in  persons  bitten 
by  animals  proved  to  be  rabid,  who  have  subsequently 
had  the  anti-rabic  treatment,  has  been  reduced  to  less 
than  one-half  per  cent.  The  disease  may  be  stamped 
out  in  dogs  by  careful  quarantine  of  suspected  animals 
and  by  a  thoroughly  carried  out  muzzling  order. 

Afa/arta.-Among    the    most    remarkable    of    modem 
discoveries  is  the  cause  of  malarial  fever,  one  of  the  great 
mahidies  of  the  world,  and  a  prime  obstacle  to  the  settle- 
ment of  Europeans  in  tropical  regions.    UntU  1880  the 
cause  was  quite  obscure.    It  was  known  that  the  disease 
prevailed  chiefly  in  marshy  districts,  in  the  autumn,  and 
that  the  danger  of  infection  was  greatest  in  the  evenmg 
and  at  night,  and  that  it  was  not  directly  contagious. 
In  1880  a  French  army  surgeon.  Laveran.  discovered  m 
the  red  blood-corpuscles  small  bodies  which  have  proved 
to  be  the  specific  germ  of  the  disease.    They  are  not 
bacteria,  but  little  animal  bodies  resembling  the  amoeba 
-tiny  Uttle  portions  of  protoplasm.    The  parasite  m  its 
earUest  form  is  a  small,  clear,  ring-shaped  body  inside 
the  red  blood-corpuscle,  upon  which  it  feeds,  gradually 
increasing  in  size  and  forming  within  itself  blackish  grains 
out  of  the  colouring  matter  of  the  corpuscle.    When  the 
little  parasite  reaches  a  certain  size  it  begins  to  divide 
or  multiply,  and  an  enormous  number  of  these  breaku.g 
up  at  the  same  time  .nve  of!  poison  in  the  blood,  which 
causes  the  paroxysms  of  fever.    Duirng  what  is  known 
as  the  chill,  in  the  intermittent  fever,  for  example,  one  can 
always  find   these  dividing  parasites.    Several  different 
forms  o!  the  parasites  have  been  found,  corresponding  to 
different  varieties  of  malaria.    Parasites  of  a  very  simUar 

262 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
nature  exist  abundantly  in  birds.  Ross,  an  army  surgeon 
in  India,  found  that  the  spread  of  this  parasite  from  bird 
to  bird  was  effected  through  the  intervention  of  the 
mosquito.  The  parasites  reach  maturity  in  certam  cells 
of  the  coats  of  the  stomach  of  these,  insects,  and  develop 
into  peculiar  thread-like  bodies,  many  of  which  ultimately 
reach  the  salivary  gknds,  from  which,  as  the  insect  bites, 
they  pass  with  the  secretion  of  the  glands  into  the  wound 
From  this  as  a  basis,  numerous  observers  have  worked 
out  the  relation  of  the  mosquito  to  malaria  m  the  human 

subject.  , 

Briefly  stated,  the  disease  b  transmitted  chiefly  by 
certain  varieties  of  the  mosquito,  particularly  the  Am- 
phdes.    The  ordinary  Culex,  which  is  present  chiefly  in 
the  Northern  States,  does  not  convey  the  disease.    The 
Anovhdes  sucks  the  blood  from  a  person  infected  with 
malaria,  takes  in  a  certain  number  of  parasites,  which 
undergo  development  in  the  body  of  the  insect,  the  final 
outcome  of  which  is  numerous  small,  thread-like  struc- 
tures, which  are  fomid  in  numbers  in  the  salivary  glands. 
From  this  point,  when  the  mosquito  bites  another  m- 
dividual.  they  pass  into  his  bloo<l,   infect  the  system, 
and  in  this  way  the  disease  is  transmitted.    Two  very 
striking   experiments   may   be   mentioned.      The   Italian 
obaervers  have  repeatedly  shown  that  Anopheles  which 
have  sucked  blood  from  patients  suffering  from  malana 
when  sent  to  a  non-malarial  region,  and  there  allowed 
to  bite  perfectly  healthy  persons,  have  transmitted  the 
disease      But  a   very  crucial   experiment   was  made   a 
short  ume  ago.     Mosquitoes  which  had  bitten  malarial 
patients  ai  Ua^  were  sent  to  London  and  there  allowed 
*^  268 


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MEDiaNE  IN  THE  NINETEENTH  CENTURY 

to  bite  Bfr.  Hanson,  son  of  Dr.  Blanson,  who  really  sug- 
gested the  mosquito  theory  of  malaria.  This  gentle- 
man had  not  lived  out  of  England,  and  there  is  no  acute 
malaria  in  London.  He  had  been  a  perfectly  healthy, 
strong  man.  In  a  few  days  following  the  bites  of  the 
infected  mosquitoes  he  had  a  typical  attack  of  malarial 
fever. 

The  other  experiment,  though  of  a  different  character, 
is  quite  as  convincing.  In  certain  regions  about  Rome, 
in  the  Campania,  malaria  is  so  prevalent  that  in  the 
autumn  almost  every  one  in  the  district  is  attacked, 
particularly  if  he  is  a  new-comer.  Dr.  Sambron  and  a 
friend  lived  in  this  district  from  June  1  to  September  1, 
1900.  The  test  was  whether  they  could  live  in  this  exceed- 
ingly dangerous  climate  for  the  three  months  without 
catching  malaria,  if  they  used  stringent  precautions 
against  the  bites  of  mosquitoes.  For  this  purpose  the 
hut  in  which  they  lived  was  thoroughly  wired,  and  they 
slept  with  the  greatest  care  under  netting,  Both  of  these 
gentlemen  at  the  end  of  the  period  had  escaped  the  disease. 

The  importance  of  these  studies  cannot  be  overestimated. 
They  explain  the  relation  of  malaria  to  marshy  districts, 
the  seasonal  incidence  of  the  disease,  the  nocturnal  infection, 
and  many  other  hitherto  obscure  problems.  More  important 
still,  they  point  out  clearly  the  way  by  which  malaria 
may  be  prevented:  First,  the  recognition  that  any 
individual  with  malaria  is  a  source  of  danger  in  a  com- 
munity, so  that  he  must  be  thoroughly  treated  with 
quinine ;  secondly,  the  importance  of  the  draining  of 
marshy  districts  and  ponds  in  which  mosquitoes  breed  ; 
and,  thirdly,  that  even  in  the  most  infected  regions  persons 

264 


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MEDICINE  IN  THE  NINETEENTH  CENTURY 

may  escape  the  diseaso  by  living  in  thoroughly  protected 
houiies,  in  this  way  escaping  the  bites  of  mosquitoes. 

Venereal   Disease' .—1  o  ^^  continue  to  embarrass  the 
social  economist  undt  \'.  p?rpi'x  *nd  distress  the  profession. 
The  misery  and  iU-hcA  th  .  "lich  ihey  cause  are  incalculable, 
and  the  pity  of  i.  :■  tbr,    ttc  c»088  is  not  always  borne 
by  the  offender,  but  iniioc?  .t  women  and  children  share 
the   penalties.    The   gonorrhoeal   infection,   so   common, 
and  often  so  little  heeded,  is  a  cause  of  much  disease  in 
parts  other   than   those   first  affected.    Syphilis   claims 
its  victims  in  every  rank  of  life,  at  every  age,  and  in  all 
countries.    We  now  treat  it  more  thoroughly,  but  all 
attempts  to  check  its  ravages  have  been  fruitless.  Physicians 
have  two  important  duties :    the  mcessant  preaching  of 
continence  to  young  men,  and  scrupulous  care,  in  every 
case,  that  the  disease  may  not  be  a  source  of  infection 
to  others,  and  that  by  thorough  treatment  the  patient 
may  be  saved  from  th«^  serious  late  nervous  manifestations. 
We  can  also  urge  that  in  the  interests  of  public  health 
venereal  diseases,   like  other  ijife-tions,  shall  be  subject 
to  supervision  by  th«  State.    The  opposition  to  measures 
tending  to  the  restriction  of  these  diseases  is  most  natural : 
on  the  one  hand,  fron»   women,  who  feel  that  it  is  an 
aggravation  of  a  shocking  injustice  and  wrong  to  their  sex  ; 
on  the  other,  from  those  who  fee'  the  moral  guilt  in  a  legal 
recognition  of  the  evil.    It  is  appalling  to  contemplate 
the  frightful  train  of  miseries  which  a  single  diseased 
woman  may  entail,  not  alone  on  her  associates,  but  on 
scores  of  the  innocent — whose  bitter  cry  should  make  the 
opponents  of  legislation  feel  that  any  measures  of  restric- 
tion, any  measures  ff  registration,  would  be  preferable 

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MEDICTNE  IN  THE  NINETEENTH  CENTURY 

to  the  present  disgraceful  condition,  which  makes  of  some 
Christian  cities  open  brothels  and  allows  the  purest  homes 
to  be  invaded  by  the  most  loathsome  of  all  diseases. 

LeproBy.—Since  the  discovery  of  the  germ  of  this 
terrible  disease  systematic  efforts  have  been  made  to 
improve  the  state  of  its  victims  and  to  promote  the  study 
of  the  conditions  under  which  the  disease  prevails.  The 
English  Leprosy  Commission  has  done  good  work  in 
calling  attention  to  the  widespread  prevalence  of  the 
disease  in  India  and  in  the  East  In  this  country  leprosy 
has  been  introduced  into  San  Fransisco  by  the  Chinese, 
anr?  into  the  North-western  States  by  the  Norwegians, 
and  there  are  foci  of  the  disease  in  the  Southern  States, 
Pftrtic'ilarly  Louisiana,  and  in  the  province  of  New  Bruns- 
wick. The  problem  has  an  additional  interest  since  the 
annexation  of  Hawaii  and  the  Philippine  Islands,  in  both 
of  which  places  leprosy  prevails  extensively.  By  systematic 
measures  of  inspection  and  the  segregation  of  affected 
individuals  the  disease  can  readily  be  held  in  check.  It 
is  not  likely  ever  to  increa-se  among  native  Americans, 
or  again  gain  such  a  foothold  as  it  had  in  the  Middle 
Ages. 

Puerperal  Fever.  -Perhaps  one  of  the  most  striking  of  all 
victories  of  preventive  medicine  has  been  the  almost  total 
abolition  of  so-called  child-bed  fever  from  the  maternity 
hospitals  and  from  private  practice.  In  many  institutions 
the  mortality  after  child-birth  was  five  or  six  per  cent., 
indeed  sometimes  as  high  as  ten  per  cent.,  whereas  to-day, 
owing  entirely  to  proper  antiseptic  precautions,  the 
mortality  has  fallen  to  three-tenths  to  four-tenths  per  cent. 
The  recognition  of  the  contagiousness  of  puerperal  fever 

266 


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MEDICINE  IN  THE  NINETEENTH  CENTURY 

was  the  most  valuable  contribution  to  medical  science 
made  by  Oliver  Wendell  Holmes.  There  had  been  previous 
suggestions  by  several  writers,  but  his  essay  on  the  "  Con- 
tagiousness of  Puerperal  Fever,"  published  in  1843,  was 
the  first  strong,  clear,  logical  stateme  ''.e   ase.    Sem- 

melwcis,  a  few  years  later,  added  ght  of  a  large 

practical  experience  to  the  side  of  the  coi  piousness,  but 
the  full  recognition  of  the  causes  of  the  disease  was  not 
reached  until  the  recent  antiseptic  views  had  been  put  into 
practical  effect. 

THE    NEW   SCHOOL   OP   MEDICINE 

The  nineteenth  cc-tury  has  witnessed  a  revolution  in 
the  treatment  of  disease,  and  the  growth  of  a  new  school 
of  medicine.  The  old  schools— regular  and  homoeopathic- 
put  their  trust  in  drugs,  to  give  which  was  the  alpha  and 
the  omega  of  their  practice.    For  every  symptom  there 
were  a  score  or  more  of  medicines— vile,  naubcoua  com- 
pounds in    one  case;    bland,  harmless  dilutions  in  the 
other.    The  characteristic  of  the  New  School  is  firm  faith 
in  a  few  good,  well-tried  drugs,  little  or  none  in  the  great 
mass  of  medicines  still  in  general  use.    Imperative  drugging 
—the  ordering  of  medicine  in  any  and  every  malady— 
ia  no  longer  n^garded  as  the  chief  function  of  the  doctor. 
Naturally,  when  the  entire  conception  of  the  disease  was 
changed,   there   came   a   corresponding   change    in   our 
therapeutics.    In  no  respect  is  this  more  strikingly  shown 
than  in  our  present  treatment  of  fever— say,  of  the  common 
typhoid  fever.    During  the  first  quarter  of  the  century 
the  patients  were  bled,  blistered,  purged  and  vomited, 
and  dosed  with  mercury,  antimony,  and  other  compounds 

267 


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MEDICINE  IN  THE  NINETEENTH  CENTURY 

to  meet  special  symptoms.  During  the  second  quarter 
the  same,  with  variations  in  different  countries.  After 
1850  bleeding  became  less  frequent,  and  the  experiments 
of  the  Paris  and  Vienna  schools  began  to  shake  the  belief 
in  the  control  of  fever  by  drugs.  During  the  last  quarter 
sensible  doctors  have  reached  the  conclusion  that  typhoid 
fever  is  not  a  disease  to  be  treated  with  medicines,  but 
that  in  a  large  proportion  of  all  cases  diet,  nursing  and 
bathing  meet  the  indications.  There  is  active,  systematic, 
careful,  watchful  treatment,  but  not  with  drugs.  The 
public  has  not  yet  been  fully  educated  to  this  point,  and 
medicines  have  sometimes  to  be  ordered  for  the  sake  of 
their  friends,  and  it  must  be  confessed  that  there  are  still 
in  the  ranks  antiques  who  would  insist  on  a  dose  of  some 
kind  every  few  hours. 

The  battle  against  poly-pharmacy,   or  the  use  of  a 
large  number  of  drugs  (of  the  action  of  which  we  know 
little,  yet  we  put  them  into  bodies  of  the  action  of  which 
we  know  less),  has  not  been  fought  to  a  finish.    There 
have  been  two  contributing  factors  on  the  side  of  progress 
— the  remarkable  growth  of  the  sceptical  spirit  fostered 
by  Paris,  Vienna  and  Boston  physicians,  and,  above  all, 
the  valuable  lesson  of  homoeopathy,   the  infinitesimals 
of  which  certainly  could  not  do  harm,  and  quite  as  certainly 
could  not  do  good ;  yet  nobody  has  ever  claimed  that  the 
mortality  among  homoeopathic  practitioners  was  greater 
than  among  those  of  the  regular  school.    A  new  school 
of  practitioners  has  arisen  which  cares  nothing  for  homoeo- 
pathy and  less  for  so-called  allopathy.    It  seeks  to  study, 
rationally  and  scientifically,  the  action  of  drugs,  old  and 
new.    It  is  more  concerned  that  a  physician  shall  know 

268 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

how  to  apply  the  few  great  medicines  which  all  have  to  use, 
such  as  quinine,  iron,  mercury,  iodide  of  potassium,  opium 
and  digitalis,  than  that  he  should  employ  a  multiplicity 
of  remedies  the  action  of  which  is  extremely  doubtful. 

The  growth  of  scientific  pharmacology,  by  which  wc 
now  have  many  active  principles  instead  of  crude  drugs, 
and  the  discovery  of  the  art  of  i  aking  medicines  palatable, 
have  been  of  enormous  aid  in  rational  practice.  There 
is  no  limit  to  the  possibility  of  help  from  the  scientific 
investigation  of  the  properties  and  action  of  drugs.  At 
any  day  the  new  chemistry  may  give  to  us  remedies  of 
extraordinary  potency  and  of  as  much  usefulness  as 
cocaine.  There  is  no  reason  why  we  should  not  even  in 
the  vegetable  world  find  for  certain  diseases  specifics 
of  virtue  fully  equal  to  that  of  quinine  in  the  malarial 

fevers. 

One  of  the  most  striking  characteristics  of  the  modern 
treatment  of  disease  is  the  return  to  what  used  to  be 
called  the  natural  methods— diet,  exercise,  bathing  and 
massage.    There  probably  never  has  been  a  period  in 
the  history  of  the  profession  when  the  value  of  diet  in 
the  prevention  and  the  cure  of  disease  was  more  fully 
recognized.    Dyspepsia,    the   besetting    malady    of   this 
country,  is  largely  due  to  improper  diet,  imperfectly  pie- 
pared  and  too  hastily  eaten.    One  of  the  great  lessons  to 
be  learned  is  that  the  preservation  of  health  depends  in 
great  part  upon  food  well  cooked  and  carefully  eaten. 
A   common   cause   of   ruined   digestion,   particularly   in 
young  girls,  is  the  eating  of  sweets  between  meals  and 
the  drinking  of  the  abominations  dispensed  in  the  chemists' 
shops   in   the   form   of   ice-cream   sodas,   etc.    Another 

269 


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MEDICINE  IN  THE  NINETEENTH  CENTURY 

frequent  cause  of  ruined  digestion  in  business  men  is 
the  hurried  meal  at  the  lunch-counter.    And  a  third 
factor,  most  important  of  all,  illustrates  the  old  maxim, 
that  more  people  are  killed  by  over  eating  and  diinkmg 
than  by  the  sword.    Sensible  people  have  begun  to  realize 
that  alcoholic  excesses  lead  inevitably  to  impaired  health. 
A  man  may  take  four  or  five  drinks  of  whiskey  a  day,  or 
even  more,  and  think  perhaps  that    he  transacts    his 
business  better  with  that  amount  of  stimulant;    but  it 
only  too  frequently  happens  that  early  in  the  fifth  decade, 
just  as  business  or  political  success  is  assured,  Bacchus 
hands  in  heavy  bills  for  payment,  in  the  form  of  serious 
disease  of  the  arteries  or  of  the  liver,  or  there  is  a  general 
breakdown.    With  the  introduction  of  light  beer  there 
has  been  not  only  less  intemperance,  but  a  reduction  in 
the  number  of  cases  of  organic  disease  of  the  heart,  liver 
and  stomach  caused  by  alcohol.    WTiile  temperance  in 
the  matter  of  alcoholic  drinks  is  becoming  a  characteristic 
of  Americans,  intemperance  in  the  quantity  of  food  taken 
is  almost  the  rule.    Adults  eat  far  too  much,  and  physicians 
are  beginning  to  recognize  that  the  early  degenerations, 
particularly  of  the  arteries  and  of  the  kidneys,  leading  to 
Bright's  disease,  which  were  formerly  attributed  to  alcohol 
are  due  in  large  part  to  too  much  food. 

2Vwr«tn<7.— Perhaps  in  no  particular  does  nineteenth- 
century  practice  differ  from  that  of  the  preceding  centuries 
more  than  in  the  greater  attention  which  is  given  to  the 
personal  comfort  of  the  patient  and  to  all  the  accessories 
comprised  in  the  art  of  nursing.  The  physician  has  in 
the  trained  nurse  an  assistant  who  carries  out  his  directions 
with  a  watchful  care,  is  on  the  lookout  for  danger-signals 

270 


MEDICINE  IN  THE  NINETEENTH  CENTURY 

and  with  accurate  notes  enables  him  to  estimate  the  progress 
of  a  critical  case  from  hour  to  hour.  The  intelligent, 
devoted  women  who  have  adopted  the  profession  of  nursing, 
are  not  only  in  their  mmistrations  a  public  benefaction, 
but  they  lighten  the  anxieties  which  form  so  large  a  part 
of  the  load  of  the  busy  doctor. 

Massage  and  Hydrotherapy  have  taken  their  places 
as  most  impo'i;ant  measures  of  relief  in  many  chronic 
conditions,  and  the  latter  has  been  almost  universally 
adopted  as  the  only  safe  means  of  combating  the 
high  temperatures  of  the  acute  fevers. 

Within  the  past  quarter  of  a  century  the  value  of  exercise 
in  the  education  of  the  young  has  become  recognized. 
The  increase  in  the  means  of  taking  wholesome  out-of-door 
exercise  is  remarkable,  and  should  show  in  a  few  years 
an  influence  in  the  reduction  of  the  nervous  troubles  in 
young  persons.  The  prophylactic  benefit  of  systematic 
exercise,  taken  in  moderation  by  persons  of  middle  ag?, 
is  very  great.  Golf  ana  the  bicycle  have  in  the  past  few 
years  materially  lowered  the  average  mcomes  which  doctors 
in  this  country  derive  from  persons  under  forty.  From 
the  senile  contingent — those  above  this  age— the  average 
income  has  for  a  time  been  raised  by  these  exercises,  as  a 
large  number  of  persoi^  have  been  injured  by  taking  up 
sports  which  may  be  vigorously  pursued  with  safety  only 
by  those  with  young  arteries. 

Of  three  departures  in  the  art  cf  healing,  brief  mention 
may  be  made.  The  use  of  the  extracts  of  certain  organs 
(or  of  the  organs  themselves)  in  disease  is  as  eld  as  the 
days  of  the  Romans,  but  an  extraordinary  impetus  has 
been  given  to  the  subject  by  the  discovery  of  the  curative 

271 


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MEDiaNE  IN  THE  NINETEENTH  CENTURY 

powers  of  the  extract  of  the  thyroid  gland  in  the  diseases 
Lwn  as  cretinism  and  myxcBdema.  The  brahancy 
of  the  results  in  these  diseases  has  had  no  P«^«l  "^  *^« 
history  of  modem  medicine,  but  it  camiot  be  said  that 
in  the  use  of  the  extracts  of  other  organs  for  disease  the 
results  have  fulfiUed  the  sanguine  expectations  of  many. 
There  was  not,  in  the  first  place,  the  same  pbysio bgical 
basis,  a.d  practitioners  have  used  these  extracts  too 
mdis;riminately  and  without  sufficient  knowledge  of  the 

'""^ndlv.  as  I  have  abready  mentioned,  we  possess 
a  sure  and  certain  hope  that  for  many  of  the  acute  infec- 
tions antitoxins  wiU  be  found. 

A  third  noteworthy  feature  in  modem  treatment  ha^ 
been  a  return  to  psychical  methods  of  cure,  m  which 
faUh  in  somiUng  u  suggested  to  the  patient.    After  aU, 
faith  b  the  great  lever  of  life.    Without  it.  man  can  do 
nothing;   with  it.  even  with  a  fragment   as  a  grain  oj 
mustard-seed,  all  things  are  possible  to  him.    Faith  m 
us,  faith  in  our  dmgs  and  methods,  is  the  great  stock  m 
trade  of  the  profession.    In  one  pan  of  the  balance,  put 
the  uharmacopcBias  of  the  world,  all  the  editions  from 
Lcorides  to'the  last  issue  of  the  Uni^d  States  Dispei. 
satorv  •    heap  them  on  the  scales  as  did  Eunpides  his 
S  Li  the'celebrated  contest  in  the  "  Frogs ''  •,  m  the 
other  put  the  simple  faith  with  which  from  the  days  of 
the  Pharaohs  untU  now  the  children  of  men  have  swahowed 
the  mixtures  these  works  describe,  and  the  bu^ky  ^mes 
will  kick  the  beam.    It  is  the  aurum  potaMe,  the  touch- 
stone of  success  in  medicine.    As  Galen  says,  confidence 
ltd  hope  do  more  good  than  physic-"  he  cures  most 

272 


MEDICINE  IN   THE  NINETEENTH  CENTURY 


i 


in  whom  most  are  confident."'  That  strange  compound 
of  charlatan  and  philosopher,  Paracelsus,  encouraged 
his  patients  "  to  have  a  good  faith,  a  strong  imagination, 
and  they  shall  find  the  effects"  (Burton).  While  we 
doctors  often  overlook  or  are  ignorant  of  our  own  faith- 
cures,  we  are  just  a  wee  bit  too  sensitive  about  those  per- 
formed outside  our  ranks.  We  have  never  had,  and 
cannot  expect  to  have,  a  monopoly  in  this  panacea,  which 
is  open  to  all,  free  as  the  sim,  and  which  may  make  of 
every  one  in  certain  cases,  as  was  the  Lacedemonia  i  of 
Homer's  day,  "  a  good  physician  out  of  Nature's  grace." 
Faith  in  the  gods  or  in  the  saints  cures  one,  fa'th  in  little 
pills  another,  hypnotic  suggestion  a  third,  faith  in  a  plain 
common  doctor  a  fourth.  In  all  ag'^s  the  prayer  of 
faith  has  healed  the  sick,  and  the  mental  attitude  of  the 
suppliant  seems  to  be  of  more  consequence  than  the 
powers  to  which  the  prayer  is  addressed.  The  cures  in 
the  temples  of  iEsculapius,  the  miracles  of  the  saints,  the 
remarkable  cures  of  those  noble  men,  the  Jesuit  .nission- 
aries,  in  this  country,  the  modern  miracles  at  Lourdes 
and  at  St.  Aime  de  Beaupre  in  Quebec,  and  the  wonder- 
workings  of  the  so-called  Christian  Scientists,  are  often 
genoine,  and  must  be  considered  in  discussing  the  founda- 
tions of  therapeutics.  We  pli/sicians  use  the  same  power 
every  day.  If  a  poor  lass,  paralyzed  apparently,  helpless, 
bed-ridden  for  years,  comes  to  me,  having  worn  out  in 
mind,  body  and  estate  a  devoted  family ;  if  she  in  a 
few  weeks  or  less  by  faith  in  me,  and  faith  alone,  takes 
up  her  lod  and  walks,  the  saints  of  old  could  not  have 
done  more,  St.  Anne  and  many  others  can  scarcely 
to-day  do  less.  We  enjoy,  I  say,  no  monopoly  in  the  faith 
AE.  273  T 


if. 


M 


,1     '    •    !« 

fill. 


\ 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
buBinew.  The  faith  with  which  we  work,  the  faith, 
indeed,  which  is  available  to-day  in  everyday  Ufe  has 
its  limitations.  It  will  not  raise  the  dead ;  it  will  not  put 
in  a  new  eye  in  place  of  a  bad  one  (as  it  did  to  an  Iroquois 
Indian  boy  for  one  of  the  Jesuit  fathers),  nor  will  it  cure 
cancer  or  pneumonia,  or  knit  a  bone ;  but.  in  spite  of  these 
nmeteenth-oentury  restrictions,  such  as  we  find  it.  faitn 
iB  a  most  precious  commodity,  without  which  we  should 

be  very  badly  off.  .  , 

Hypnotism,  introduced  by  Mesmer  m  the  eighteenth 
cent!^.  has  had  several  revivals  as  a  method  of  treatment 
during  the  nineteenth  century.     The  first  careful  study 
of  it  was  made  by  Braid,  a  Manchester  surgeon,  who 
introduced  the  terms  hypnotism,   hypnotic,  and  nervous 
sleep ;  but  at  this  time  no  very  great  measure  of  success 
followed  its  use  in  practice,  except  perhaps  in  the  case  of 
an  Anglo-Indian  surgeon.  James  Esdaile,  who.  pnor  to 
the  introduction  of  anesthesia,  had  performed  two  hundred 
and  sixty-one  surgical  operations  upon   patients  m  a 
state  of  hypnotic  unconsciousness.    About  1880  the  French 
physicians,    particularly    Charcot    and   Bernheim.    took 
up  the  study,  and  since  that  time  'aypnotism  has  been 
extensively  practised.    It  may  be  defined  as  a  subjective 
psychical  condition,  which  Braid  called  nervous  sleep, 
resembUng  somnambulism,  in  which,  as  Shakespeare  says, 
in  the  description  of  Lady  Macbeth,  the  person  receives 
at  once  the  benefit  of  sleep  and  does  the  effects  or  acts 
of  watching  or  waking.    Therapeutically,  the  important 
fact  is  that  the  individual's   natural  sut  eptibilit>   to 
suggestion  is  increased,  and  this  may  hold  aftc-  the  condi- 
tion of  hypnosis  has  passed  away .  The  condition  of  hypnosis 

274 


\ 


MEDiaNE  IN  THE  NINETEENTH  CENTURY 

is  usually  itself  induced  by  suggestion,  requesting  the 
subject  to  close  the  eyes,  to  think  of  sleep,  and  the  operator 
then  repeats  two  or  three  times  sentences  suggesting 
sleep,  and  suggesting  that  the  limbs  are  getting  heavy 
and  that  he  is  feeling  drowsy.  During  this  state  it  has 
been  found  that  the  subjects  are  very  susceptible  to  sugges- 
tion. Too  much  must  not  be  expected  of  hypnotism, 
and  the  claims  which  have  been  m^'\e  for  it  have  been 
too  oiten  groRsly  exaggerated.  It  seems,  as  it  has  been 
reo'-  ''  jqV  put,  that  hypnotism  "at  best  permits  of 
nu  .  gestions  more  effective  for  good  or  bad  than 

c»>  '■  -i  upon  one  in  his  waking  state."    It  is  found 

to  ...  ^^  very  ittle  use  in  organic  disease.  It  has  been 
helpful  in  some  cases  of  hysteria,  in  certain  functional 
spasmodic  affections  of  the  nervous  system,  in  the  vicious 
habits  of  childhood,  and  m  suggesting  to  the  victims  of 
alcohol  and  drugs  that  they  should  get  rid  of  their  inordi- 
nate desires.  It  has  been  used  successfully  in  certain 
cases  for  the  relief  of  labour  pains,  and  in  surgical  opera- 
tions ;  but  on  the  whole,  while  a  valuable  agent  in  a  few 
cases,  it  has  scarcely  fulfilled  the  expectations  of  its 
advocates.  It  is  a  practice  not  without  serious  dangers, 
and  should  never  be  performed  except  in  the  presence  of 
a  third  person,  while  its  indiscriminate  employment  by 
ignorant  persons  should  be  prevented  by  law. 

One  mode  of  faith-healing  in  modern  days,  which  passes 
under  the  remarkable  name  of  Christian  Science,  is  probablv 
nothing  more  than  mental  suggestion  under  another 
name.  "  The  atient  is  told  to  be  calm,  and  is  assured 
that  all  will  go  well ;  that  he  must  try  to  aid  the  healer 
by  believing  that  what  is  told  him  is  true.    The  healer 

276 


'V,  I 


f  1 

i 

I 


MEDICINE  IN  THE  NINETEENTH  CENTURY 
then,  quietly  but  finnly.  asserts  and  reiterates  that  there 
is  no  pain,  no  suffering,  that  it  U  disappearing,  that  relief 
wiU  come,  that  the  patient  is  getting  well.      This  « 
precisely  the  method  which  Bernheim  used  to  use  with 
such  success  with  his  hypno€tic  patients  at  Nancy  itera:  mg 
and  reiterating,  in  a  most  wearUome  way,  that  the  disease 
would  disapFar  and  the  patient  would  feel  better.    As 
has  been  pointed  out  by  a  recent  writer  (Dr.  Harry  Mar- 
shall) the  chief  basis  for  the  growth  of  Christian  Science 
is  that  which  underlies  every  popular  fallacy:    "Oliver 
WendeU  Holmes  outlined  very  clearly  the  factors  concerned 
showing  (a)  how  easUy  abundant  facts  can  be  coUected 
to    prove    anything    whatsoever;     (b)    how    insufficient 
•  exalted  wisdom,  immaculate  honesty,  and  vast  general 
acquirements'  are  to  prevent  an  individual  from  having 
the  most  primitive  ideas  upon  subjects  out  of  his  line  of 
thought;     and.    finally,    demonstrating    'the    boundless 
credulity  and  excitability  of  mankind  upon  subjects  con- 
nected with  medicine.' " 


276 


XIV 
CHAUVINISM  IN  MEDICINE 


i 


277 


1 1 


1,  ■'• 


<      ' 


I  (eel  not  in  my«elf  thow  common  antipat  .es  th»t  I  can  Ab 

cover  in  other. :  tboae  national  repugnances  do  not  touch  me.  nor 

do  I  behold  with  preiudicetheFrench.ItaUan  Spamard  orDutJ. 

but  where  I  find  their  actions  in  balance  with  my  countrymen -. 

I  honour,  love,  and  embrace  them  in  the  same  degree.    I  was  born 

n  the  eighth  climate,  but  seem  for  to  be  framed  and  con-teUated 

^nto  aU :  I  am  no  plant  that  wiU  not  prosper  out  of  a.garden  ;  all 

place..  aU  airs,  make  unto  me  one  country ;  I  am  m  England. 

everywhere,  and  under  any  taer'  '«*n.  m.a« 

All's  not  offence  that  indiscretion  finds 

And  dotage  terms  so.  ».•  „  r.«.  Art  TI 

Shakispkaei,  King  Lear,  Act  ii. 

Still  in  thy  right  hand  carry  gentle  peace. 
To  sUence  envious  tongues.  vniXctlll 

Shamspeabe,  King  Henry  VIII,  Act  III. 


LtJd 


i.--.^L, 


278 


XIV 
CHAUVINISM'  IN  MEDICINE* 

A  RARE  and  precious  gift  is  the  Art  of  Detach     nt, 
by  which  a  man  may  so  separate  himself  from  a 
life-long  environment  as  to  take  a  panoramv.  view  of  the 
conditions  under  which  he  has  liv.  1  ^nd  movei:  it  frees 
him  from  Plato's  den  long  enough  to  see  the  realities  as 
they  are,  the  shadows  as  they  ap^ar.    Could  a  physi- 
cian  attain  to  such  an  art  he  would  find  in  the  state  of  his 
profession  a  theme  calling  as  well  for  the  exercise  c^  the 
highest  faculties  of  description  and  imagination  as  for  the 
deepest  phUosophic  insight.    With  wisdom  of  the  den 
only  and  of  my  fellow-prisoners,  such  a  task  is  beyond  my 
ambition  and  my  powers,  but  to  emphasizr  duly  the  sub- 
ject that  I  wish  to  bring  home  to  your  hearts  I  must  first 
refer  to  certain  distinctive  features  of  our  profession  : 

I.    FOUR  GREAT   FEATURES  OF  THE   GUILD 
Its  mUe  ancarfrt/.-Like  everything  else  that  is  good 
and  durable  in  this  world,  modern  medicine  is  a  product 
of  the  Greek  intellect,  and  had  its  origin  when  that  won- 

1  Definition:  A  narrow.   ilUberal  spirit  in  matters  national* 
provincial,  collegiate,  or  personal. 

a  Canadian  Medital  Association,  Montreal,  1902. 

279 


•i!. : 


u 


II 

(     4 
I 

I! 


i  \ 


CHAUVINISM  IN  MEDICINE 

derful  people  created  positive  or  rational  science,  and  no 
small  credit  is  due  to  the  physicians  who,  a&  Professor 
Gomperz  remarks  (in  his  brilliant  chapter  "  On  the  Age 
of  Enlightenment,"  Greek  Thinkers,  Vol.  1),  very  early 
brought  to  bear  the  spirit  of  criticism  on  the  arbitrary 
and  superstitious  views  of  the  phenomena  of  life.    If 
science  was  ever  to  acquire  "  steady  and  accurate  habits 
instead  of  losing  itself  in  a  maze  of  phantasies,  it  must  be  by 
quiet  methodical  research."    "  It  is  the  undying  glory  of 
the  school  of  Cos  that  it  introduced  this  innovation  into 
the  domain  of  its  Art,  and  thus  exercised  the  most  bene- 
ficial influence  on  the  whole  intellectual  life  of  mankind! 
Fiction  to  the  right !    Reality  to  the  left !  was  the  battle 
cry  of  this  school  in  the  war  it  was  the  first  to  wage  against 
the  excesses  and  defects  of  the  nature  philosophy  "  (Gom- 
perz).   The  critical  sense  and  sceptical  attitude  of  the 
Hippocratic  school  laid  the  foundations  of  modem  medi- 
cine on  broad  lines,  and  we  owe  to  it :  first,  the  emanci- 
pation of  medicine  from  the  shackles  of  priestcraft  and  of 
caste  ;  secondly,  the  conception  of  medicine  as  an  art  based 
on  accurate  observation,  and  as  a  science,  an  integral  part 
of  the  science  of  man  and  of  nature  ;  thirdly,  the  high  moral 
ideals,  expressed  in  that  most  "memorable  of  human 
documents"   (Gomperz),  the     Hippocratic    oath;    and 
fourthly,  the  conception  and  realization  of  medicine  as  the 
profession  of  a  cultivated  gentleman.*     No  other  profes- 

t  Nowhere  in  literature  do  we  have  such  a  charming  picture 
illustrating  the  position  of  a  cultivated  physician  in  society  as  that 
given  in  Plato's  Dialogues  of  Eryximachus,  himself  the  son  of  a 
physician,  Acumenus.  In  that  most  briUiant  age  the  physician 
was  the  companion  and  friend,  and  in  intellectual  intercourse  the 
peer  of  its  choicest  spirits, 

280 


^ 


CHAUVINISM  IN  MEDICINE 

9ion  can  boast  of  the  same  unbroken  continuity  of 
methods  and  of  ideals.  We  may  indeed  be  justly  proud  of 
our  apostolic  succession.  Schools  and  systems  have  flou- 
rished and  gone,  schools  which  have  swayed  for  genera- 
tions the  thought  of  our  guild,  and  systems  that  have 
died  before  their  founders ;  the  philosophies  of  one  age 
have  become  the  absurdities  of  the  next,  and  the  foolish- 
ness of  yesterday  has  become  the  wisdom  of  to-morrow ; 
through  long  ages  which  were  slowly  learning  what  we  are 
hurrying  to  forget— amid  all  the  changes  and  chances 
of  twenty-five  centuries,  the  profession  has  never  lacke«l 
men  who  have  lived  up  to  these  Greek  ideals.  They 
were  those  of  (Jalen  and  of  Aretseus,  of  the  men  of  the 
Alexandrian  and  Byzantine  schools,  of  the  beat  of  the 
Arabians,  of  the  men  of  the  Renaissance,  and  they  are 
ours  to-day. 

A  second  distinctive  feature  is  the  remarkable  solidarity. 
Of  no  other  profession  is  the  word  universal  applicable 
in  the  same  sense.  The  celebrated  phrase  used  of  the 
Catholic  Church  is  in  truth  much  more  appropriate  when 
applied  to  medicine.  It  is  not  the  prevalence  of  disease 
or  the  existence  ever3rwhere  of  special  groups  of  men  to 
treat  it  that  betokens  this  solidarity,  but  it  is  the  identity 
throughout  the  civilized  world  of  our  ambitions,  our 
methods  and  our  work.  To  wrest  from  nature  the  secrets 
which  have  perplexed  philosophers  in  all  ages,  to  track 
to  theur  sources  the  causes  of  disease,  to  correlate  the  vast 
stores  of  knowledge,  that  they  may  be  quickly  available 
for  the  prevention  and  cure  of  disease— these  are  our  am- 
bitions. To  carefully  observe  the  phenomena  of  life  in 
all  its  phases,  normal  and  perverted,  to  make  perfect  that 

281 


( i 


\i\\. 


•  •U 


h 


,  J 


H  I 


CHAUVINISM  IN  MEDICINE 
most  difficult  of  aU  arts,  the  art  oi  observation,  to  caU  to 
aid  the  science  of  experimentation,  to  cultivate  the  reason- 
ing  faculty,  so  as  to  be  able  to  know  the  true  from  the 
false-these  are  our  methods.  To  prevent  disease,  to  re- 
Ueve  suffering  and  to  heal  the  sick-this  is  o;^  work. 
The  profession  in  truth  is  a  sort  of  guild  or  brotherhood, 
any  member  of  which  can  take  up  his  calling  m  any  part 
of  the  world  and  find  brethren  whose  language  and  methods 
and  whose  aims  and  ways  are  identical  with  his  own. 

Thirdlv    its  progressive  char  octet. -Based  on  science, 
medicine  has  followed  and  partaken  of  its  fortunes,  so 
that  in  the  great  awakening  which  has  made  the  nme- 
teenth  memorable  among  centuries,  the  profession  re- 
ceived a  quickening  impulse  more  powerful  than  at  any 
period  in  its  history.    With   the   sole  exception  of  the 
mechanical  sciences,  no  other  department  of  hmnan  know- 
ledge has  undergone  so  profound  a  change-a  change  30 
profound  that  we  who  have  grown  up  in  it  have  but  slight 
appreciation  of  its  momentous  character.    And  not  only 
in  what  lias  been  actually  accomplished  in  unravelUng 
the  causes  of  disease,  in  perfecting  methods  of  prevention, 
and  in  wholesale  relief  of  suffering,  but  also  m  the  un- 
loading of  old  formulae  and  in  the  substitution  of  the 
scientific  spirit  of  free  inquiry  for  cast-iron  dogmas  we  see 
a  promise  of  still  greater  achievement  and  of  a  more 

glorious  future. 

And  lastly,  the  profession  cf  medicine  is  distinguished 
from  aU  others  by  its  singular  beneficence.  It  alone  does 
the  work  of  charity  in  a  Jovian  and  God-like  way,  dis- 
pensing with  free  hand  truly  Promethean  gifts.  There 
are  those  who  listen  to  me  who  have  seen  three  of  the  most 

282 


A 


CHAUVINISM  IN  MEDICINE 

benign  endowments  granted  to  the  race  since  the  great 
Titan  stole  fire  from  the  heavens.    Search  the  scriptures 
of  human  achievement  and  you  cannot  find  any  to  equal 
in  beneficence  the  introduction  of  Anesthesia,  Sanitation, 
with  all  that  it  includes,  and  Asepsis— a  short  half-century's 
contribution  towards  the  practical  solution  of  the  pro- 
blems of  human  suffering,  regarded  as  eternal  and  insolu- 
ble.   We  form  almost  a  monopoly  or  trust  in.  this  busi- 
ness.   Nobody  else  comes  into  active  competition  with 
us,  certainly  not  the  other  learned  professions  which  con- 
tinue along  the  old  lines.    Every  few  years  sees  some  new 
conquest,  so  that  we  have  ceased  to  wonder.    The  work 
of  half  a  dozen  men,  headed  byLaveran,  has  made  waste 
places  of  the  earth  habitable  and  the  wilderness  to  blossom 
as  the  rose.    The  work  of  Walter  Reed  and  his  associates 
will  probably  make  yellow  fever  as  scarce  in  the  Spanish 
Main  as  is  typhus  fever  with  us.    There  seems  to  be  no 
limit  to  the  possibilities  of  scientific  medicine,  and  while 
philanthropists  are  turning  to  it  as  to  the  hope  of  hiaman- 
ity,  philosophers  see,  as  in  some  far-off  vision,  a  science 
from  which  may  come  in  the  prophetic  words  of  the  Son 
of  Sirach,  "  Peace  over  all  the  earth." 

Never  has  the  outlook  for  the  profession  been  brighter. 
Everywhere  the  physician  is  better  trained  and  better 
equipped  than  he  was  twenty-five  years  ago.  Disease 
is  understood  more  thoroughly,  studied  more  carefully  and 
treated  more  skilfully.  The  average  sum  of  human  suf- 
fering has  been  reduced  in  a  way  to  make  the  angels  re- 
joice. Diseases  familiar  to  our  fathers  and  grandfathers 
have  disappeared,  the  death  rate  from  others  is  falling 
to  the  vanishing  point,  and  public  health  measures  hav 

288 


[  * 
Hi 


I 


1/^ 


h    i! 


CHAUVINISM  IN  BIEDICINE 

lessened  me  sorrows  and  brightened  the  lives  of  millions. 
The  vagaries  and  whims,  lay  and  medical,  may  neither 
have  diminished  in  number  nor  lessened  in  their  capacity 
to  distress  the  faint-hearted  who  do  not  appreciate  that  to 
the  end  of  time  people  must  imagine  vain  things,  but  they 
are  dwarfed  by  comparison  with  the  colossal  advance    of 

the  past  fifty  years. 

So  vast,  however,  and  composite  has  the  profession 
become,  that  the  physiological  separation,  in  which  de- 
pendent parts  are  fitly  joined  together,  tendi  to  become 
pathological,  and  while  some  parts  suffer  necrosis  and 
degeneration,  others,  passing  the  normal  limits,  become 
disfiguring  and  dangerous  outgrowths  on  the  body  medical. 
The  dangers  and  evils  which  threaten  harmony  among  the 
units,  are  internal,  not  external.    And  yet,  in  it  more  than 
in  any  other  profession,  owing  to  the  circumstances  of 
which  I  have  spoken,  is  complete  organic  unity  poswble. 
Of  the  many  hindrances  in  the  way  time  would  fail  me  to 
speak,  but  there  is  one  aspect  of  the  question  to  which 
I  would  direct  your  attention  in  the  hope  that  1  may 
speak  a  word  in  season. 

Perhaps  no  sin  so  easily  besets  us  as  a  sense  of  self- 
satisfied  superiority  to  others.  It  cannot  always  be  called 
pride,  that  master  sin,  but  more  often  it  is  an  attitude 
of  mind  which  either  leads  to  bigotry  and  prejudice  or 
to  such  a  vaunting  conceit  in  the  truth  of  one's  own  be- 
liefs and  positions,  that  there  is  no  room  for  tolerance  of 
ways  and  thoughts  which  are  not  as  ours  are.  To  avoid 
some  smirch  of  this  vice  is  beyond  h.man  power ;  we  ...e 
all  dipped  in  it,  some  Ughtly,  others  deeply  grained.  Par- 
taking of  the  nature  of  uncharitableness,  it  has  not  the 

284 


CHAUVINISM  IN  MEDICINE 

intenBity  of  envy,  hatred  and  malice,  but  it  "hades  off 
in  fine  degrees  from  thf   ..    It  may  be  a  perk  tly  harm- 
less, even  an  amusing  trait  in    both  nations  and  indi- 
viduals, and  so  well  was  it  depicted  by  Charlet,  Horace 
Vemet,  and  others,  under  the  character  of  an  enthusiastic 
recruit  named  Chauvin,  that  the  name  Chauvinism  has 
become  a  by-word,  expressing  a  bigoted,  intolerant  spirit. 
The  significance  of  the  word  has  been  widened,  and  it  may 
b«>  used  as  a  synonym  for  a  certam  type  of  nationalism,  for 
a  narrow  provincialism,  or  for  a  petty  parochialism.    It 
does  not  express  the  blatant  loudness  of  Jingoism,  which 
is  of  the  tongue,  while  Chauvinism  is  a  condition  of  the 
mind,  an  aspect  of  character  much  more  subtle  and  dan- 
gerous.   The  one  is  more  apt  to  be  found  m  the  educated 
classes,  while  the  other  is  pandemic  in  the  fool  multitude— 
"  that  numerous  piece  of  monstrosity  which,  taken  asunder, 
seem  men  and  reasonable  creatures  of  God,  but  confused 
together,  make  but  one  great  beast,  and  a  monstrosity 
more  prodigicius  than  Hydra  "   {Rdigio  Medici).     Wher- 
ever found,  and  iu  whatever  form.  Chauvinism  is  a  great 
enemy  of  progress  and  of  peace  and  concord  among  the 
units.    I  have  not  the  time,  nor  if  I  had,  have  I  the  ability 
to  portray  this  failing  in  all  its  varieties  ;  I  can  but  touch 
upon  some  of  its  aspects,  national,  provincial  and  paro- 
chial. 


II.    NATIONALISM   IN   MEDICINE 

Nationalism  has  been  the  great  curse  of  humanity.  In 
no  other  shape  has  the  Demon  of  Ignorance  assumed  more 
hideous  propor*  >n3 ;  to  no  other  obsession  do  we  yield 
ourselves  more  readily.    For  whom  do  the  hosannas  ring 

285 


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M 


1 

i 

hi 


CHAUVINISM  IN  MEDICINE 

higher  than  for  the  succesaful  butcher  of  tens  of  thousands 
of  poor  feUows  who  have  been  made  to  pasd  through  the 
fire  to  this  Moloch  of  nationalism  ?    A  vice  of  the  blood, 
of  the  plasm  rather,  it  runs  riot  in  the  race,  and  rages  to- 
day as  of  yore  in  spite  of  the  precepts  of  reUgion  and  the 
practice  of  democracy.    Nor  is  there  any  hope  of  change  ; 
the  pulpit  is  dumb,  the  press  fans  the  flames,  Uterature 
panders  to  it  and  the  people  love  to  have  it  so.    Not  that 
aU  aspects  of  nationalism  are  bad.    Breathes  there  a  man 
with  soul  so  dead  that  it  does  not  glow  at  the  thought 
of  what  the  men  of  his  blood  have  done  and  suffered  to 
make  his  country  what  it  is  ?    There  is  room,  plenty  of 
room,  for  proper  pride  of  land  and  birth     What  I  inveigh 
against  is  a  cu-sed  spirit  of   intolerance,   conceived    in 
distrust  and  bred  m  ignorance,  that  makes  the   mental 
attitude  perenniaUy  antagonistic,  even  bitterly  antagonistic 
to  everything  foreign,  that  subordinates  everywhere  the 
race  to  the  nation,  forgetting  the  higher  claims  of  human 

brotherhood.  . 

While  medicine  is  everywhere  tinctured  with  national 
characteristics,  the  wider  aspects  of  the  proiession,  to 
which  I  have  alluded-our  common  lineage  and  the  com- 
munity of  interests-should  always  save  us  from  the  more 
vicious  aspects  of  this  sin,  if  it  cannot  prevent  it  altogether. 
And  yet  I  cannot  say,  as  I  wish  I  could,  that  we  are  whoUy 
free  from  this  form  of  Chauvinism.    Can  we  say,  as  Eng- 
lish, French,  German  or  American  physicians,  that  our 
culture  is  always  cosmopoUtan,  not  national,  that  our 
attitude  of  mind  is  always  as  frankly  open  and  friendly 
to  the  French  as  to  the  English,  to  the  American  as  to  the 
German,  and  that  we  are  free  at  aU  times  and  in  aU  places 

286 


CHAUVINISM  IN  MEDICINE 

from  prejudice,  et  all  oimes  free  from  a  self-satisfied  feeling 
of  superiority  the  ono  over  the  othe;*  ?  There  has  been 
of  late  year  J  a  closer  union  of  the  profession  of  the  different 
countries  through  the  International  Congress  and  through 
the  international  meetings  of  the  special  societies;  but 
this  is  not  enough,  aud  the  hostile  attitude  has  by  no 
means  disappeared.  Ignorance  is  at  the  root.  When 
a  man  talks  slightingly  of  t;he  position  and  work  of  his 
profession  in  any  country,  or  when  a  teacher  tells  you 
that  he  fails  to  find  inspiration  in  the  work  of  his  foreign 
colleagues,  in  the  woids  of  the  Arabian  proverb — he  is  a 
fool,  shun  him !  Full  knowledge,  which  alone  disperses 
the  mists  of  ignorance,  can  only  be  obtained  by  travel 
or  by  a  thorough  acquaintance  with  the  literature  of  the 
different  coimtries.  Personal,  first-hand  intercourse  with 
men  of  different  lands,  when  the  mind  is  young  and  plastic, 
is  the  best  vaccination  against  the  disease.  The  man 
who  has  sat  at  the  feet  of  Virchow,  or  has  listened  to 
Traube,  or  Hehnholtz,  or  Cohnheim,  can  never  look  with 
unfriendly  eyes  at  German  medicine  or  German  methods 
Who  ever  met  with  an  English  or  American  pupil  of  Louis 
or  of  CTiarcot,  who  did  not  love  French  medicine,  if  not 
for  its  own  sake,  at  least  for  the  reverence  he  bore  his  great 
master  ?  Let  our  young  men,  particularly  those  who 
aspire  to  teaching  positions,  go  abroad.  They  can  find 
at  home  laboratories  and  hospitals  as  well  equipped  as 
any  in  the  world,  but  they  may  find  abroad  more  than 
they  knew  they  sought — widened  sympathies,  heightened 
ideab  and  something  perhaps  of  a  Wdt-cultur  which  will 
remain  through  life  as  the  best  protection  against  the  vice 
of  nationalism. 

287 


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ll    I;! 


CHAUVINISM  IN  MEDICINE 
Next  to  a  personal  knowledge  oi  men,  a  knowledge  of  the 
Uterature  of"  the  profession  of  difierent  countries  wiU  do 
much  to  counteract  intolerance  and  Chauvinism.    The 
oreat  works  in  the  department  of  medicine  m  which  a 
man  is  interested,  are  not  so  many  that  he  camiot  know 
their  contents,  though  they  be  in  three  or  four  languages. 
Thuik  of  the  impetus  French  medicine  gave  to  the  pro- 
fession in  the  first  half  of  the  last  century,  of  the  debt  we 
aU  owe  to  German  science  in  the  latter  half,  and  of  the 
lesson  of  the  practical  application  by  the  English  of  sani- 
tation and  asepsis !    It  is  one  of  our  chief  glories  and  one 
of  the  unique  features  of  the  profession  that,  no  matter 
where  the  work  b  done  in  the  world,  if  of  any  value,  it 
is  quickly  utilized.    Nothing  has  contributed  more  to  the 
denationalization  of  the  profession  of  this  contment  than, 
on  the  one  hand,  the  ready  reception  of  the  good  men 
from  the  old  countries  who  have  cast  in  their  lot  with  us. 
and.  on  the  other,  the  influence  of  our  young  men  who 
have  returned  from  Europe  with  sympathies  as  wide  as 
the  profession  itself.    There  is  abroad  among  us  a  proper 
spirit  of  eclecticism,  a  willingness  to  take  the  grK)d  where- 
ever  found,  that  augurs  well  for  the  future.    It  helps  a 
man  immensely  to  be  a  bit  of  a  hero-worshipper.  and  the 
stories  of  the  Uves  of  the  wasters  of  medicine  do  much 
to  stimulate  our  ambition  and  rouse  our  sympathies.    1 
the  Ufe  and  work  of  such  men  as  Bichat  and  Laennec  wiU 
not  stir  the  blood  of  a  yomig  man  and  make  bim  feel  proud 
of  France  and  of  Frenchmen,  he  must  be  a  dull  and  muddy 
mettled  rascal.    In  reading  the  Ufe  of  Hunter,  of  Jenner. 
who  thinks  of  the  nationaUty  which  is  merged  and  lost  m 
our  interest  in  the  man  and  in  his  work  ?    In  the  halcyon 

288 


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CHAUVINISM  IN  MEDICINE 

days  of  the  Reiuussance  there  wu  nc  nationalism  in 
medicine,  but  a  fine  catholic  spirit  made  great  leaders  like 
Veealius,  Eustachius,  Stensen  and  others  at  home  in  every 
comitry  in  Europe.  While  this  is  impossible  tO'day,  a 
great  teacher  of  any  country  may  have  a  world-wide 
audience  in  our  journal  literature,  which  has  done  so 
much  to  make  medicine  cosmopolitan. 

III.   PROVINCIALISM  IN  MEDICINE 
While  we  may  congratulate  ourselves  that  the  worst 
aspects  of  nationalism  in  medicine  are  disappearing  be- 
fore the  broader  culture  and  the  more  intimate  know- 
ledge brought  by  ever-increasing  intercourse,  yet  in  Eng- 
lish-speaking   coimtries    conditions    have    favoured    the 
growth  of  a  very  unpleasant  subvariety,  which  may  be 
called  provincialism  or  sectionalism.    In  one  sense  the 
profession  of  this  continent  is  singularly  homogeneous; 
A  young  man  may  be  prepared  for  his  medical  course  in 
Louisiana  and  enter  McGUl  College,  or  he  may  enter  Dal- 
housie  College,  Halifax,  from  the  State  of  Oregon,  and  in 
either  case  he  will  not  feel  strange  or  among  strangers  so 
soon  as  he  has  got  accustomed  to  his  environment.    In 
collegiate  life  there  is  a  frequent  interchange  of  teachers 
and  professors  between  all  parts  of  the  country.    To 
better  his  brains  the  scholar  goes  freely  where  he  wishes — 
to  Harvard,  McGill,  Yale,  or  Johns  Hopkins ;  there  are 
no   restrictions.    The   various   medical   societies   of   the 
two  countries  are,  without  exception,  open  to  the  members 
of  the  profession  at  large.    The  President  of  the  Asso- 
ciation of   American   Physicians   this   year   (Dr.   James 
Stewart),  is  a  resident  of  this  city,  which  gave  also  last  year 
AE.  289  U 


'.>. 


h 


CHAXmNISM  IM  MEDICINE 

ohirf  ioJiu  «.  «PP«t«l  by  ».n  ol  .U  «*»».    T^ 
text-book.  Md  oMHuJi  U6  tyoywUn  a  ownmon .  thwe 
i,  m  l«t, .  «m«k.bl.  homogenrity  to  the  E.#«l'-I** 
*g  profe^..  not  only  on  thi.  conttoent  tat  tbroo^™^ 

r.  w«ld.    N.t«i.Uy.  to  widdy  «»tt»rf  «»»»'^'»' 

^  the  whole-*-,  exiet,  but  it  i.  dto„«»hu*  ^ 
™.t  hmrtion  ol  the  netioMl  ««c..t.on.  »  to  lo^ 
^t  J  hannony  «.d  brotherhood  .mong  the  «.t^ 
Ite  ol  these  broad  tond..  But  we  .ufier  «dly  torn  a 
^vtoeirito  which  ha.  paduJly  e«th.aU«i  «.  a-d 
'^.^  origir^y  from  au  attempt  to  rehev.  cou- 
Ition.  taeupportable  to  themaelve..    I  have  prawd  the 

^Lar^ble.aud^ttoa^t^rr^pect^-J'em^^ 

::r"^;:irrMnrSe.  the  greate-t 
p^toer.l  Uberty  may  become  iu  greateet  eng^ 
Telaver.;.  The  tyram.y  ol  Ubour  umone,  ol  truet^ 
*Id  ol  an  irreeponrible  pre- may  b«r  a.  h«»^y  2«- 
Lple  a.  autocraey  to  its  worrt  lorm.    tod,  .t«uge 

Cw  «I  fate!  «"  ^'""^^  "'  ^"™""^  "  • 
ZLha.  to>p«ed  to  a  few  years  a  TO^e -- ^^^^ 
than  that  which  atSicte  our  brethren  m  Great  Bntam, 
which  t»olc  generations  to  forge. 

ThedeUghtlul  freedom  ol  toteroooise  ol  which  I  spoUe, 
,^  wSe  and  generous,  is  Itouted  to  touUectual  and 
^  m.  «id  on  the  pr«>tical  side,  not  only  are  gemd 
Scour^ous  lacilities  lacktog,  but  the  ba»  d  a  ng.d 
provincialism  are  pat  up,  tomg  each  State  a.  wrth  a 


i 


3^; 


CHAUVINISM  IN  MEDICINE 

Chinese  wall.  In  the  Dominion  of  Canada  there  are  eight 
portals  of  entry  to  the  profession,  m  the  United  States 
ahnost  as  many  as  there  are  States,  in  the  United  King- 
dom nineteen,  I  believe,  but  in  the  latter  the  license  of  any 
one  of  these  bodies  entitled  a  man  to  registration  any- 
where in  the  kingdom.  Democracy  m  full  circle  has 
reached  on  this  hemisphere  a  much  worse  condition  than 
that  in  which  the  conservatism  of  many  generations  has 
entangled  the  profession  of  Qreat  Britain.  Upon  the 
origin  and  growth  of  the  Provincial  and  State  Boards  I 
do  not  propose  to  touch.  The  ideal  has  been  reached  so 
far  as  organization  is  concerned,  when  the  profession 
elects  its  own  Parliament,  to  which  is  committed  the  con- 
trol of  all  n  tters  relating  to  the  license.  The  recognition, 
in  some  form,  of  this  democratic  principle,  has  been  one 
great  means  of  elevating  the  standard  of  medical  edu- 
cation, and  in  a  majority  of  the  States  of  the  Union  it  has 
secured  a  minimum  period  of  four  years  of  study,  and  a 
State  Examination  for  License  to  Practice.  All  this  is  as  it 
should  be.  But  it  is  high  time  that  the  profession  real- 
ized the  anomaly  of  eight  boards  in  the  Dominion  and 
some  scores  in  the  United  States.  One  can  condone  the 
iniquity  in  the  latter  country  more  read'  -  in  Canada, 
in  which  the  boards  have  existed  for  a  k  ^or  penod,  and 
where  there  has  been  a  greater  uniformity  in  the  medical 
curriculum.  After  all  these  years  that  a  young  man,  a 
graduate  of  Toronto  and  a  registered  practitioner  m 
Ontario,  cannot  practise  in  the  Province  of  Quebec,  his 
own  country,  without  submitting  to  vexatious  penalties 
of  mind  and  pocket,  or  that  a  graduate  from  Montreal  and 
a  registered  practitioner  of  this  province  cannot  go  to 

291 


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CHAUVINISM  IN  MEDICINE 
M*nitoU,  hi»  own  country  •gain,  and  take  up  hU  Ule'fc 
work  without  additional  paymento  and  penalties,  i»,  I 
maintain,  an  outrage ;  it  is  provincUlism  run  riot.  That 
this  pestiferous  condition  should  exist  throughout  the 
various  provinces  of  this  Dominion  and  so  many  States 
of  tVe  Union,  illustrates  what  I  have  said  of  the  tyranny 
of  democracy  and  how  gr-^at  enslavers  of  liberty  its 
chief  proclaimers  may  be. 

That  the  cure  of  this  vicious  state  has  to  be  sought  in 
Dominion  biUs  and  National  examining  boards,  indicates 
into  what  debasing  depths  of  narrow  provincialism  we  have 
sunk.    The  solution  seems  to  be  so  simple,  particularly 
in  this  country,  with  its  uniformity  of  methods  of  teaching 
and  length  of  curriculum.    A  generous  spirit  that  wUl 
give  to  local  laws  a  Uberal  interpretation,  that  limits  its 
hostility  to  ignorance  and  viciousness,  that  has  regard 
as  much  or  more  for  the  good  of  the  guUd  aa  a  whole  as  for 
the  profession  of  any  province— could  such  a  spirit  brood 
over  the  waters,  the  raging  waves  of  discord  would  soon 
be  stilled.    With  the  attitude  of  mind  of  the  general  prac- 
titioner in  each  province  rests  the  solution  of  the  problem. 
Approach  it  in  a  '  lindly  and  gracious  spirit  and  the  diffi- 
culties which  seem  so  hard  will  melt  away.    Approach 
it  in  a  Chauvinistic  mood,  fuUy  convinced  that  the  superior 
and  unparalleled  conditions  of  your  province  will  be  jeo- 
pardized by  reciprocity  or  by  Federal  legislation,  and  the 
present  antiquated  and  disgraceful  system  must  await 
for  its  removal  the  awakening  of  a  younger  and  more  in- 
telligent generation. 

It  would  ill  become  me  to  pass  from  this  subject- 
familiar  to  me  from  my  student  days  from  the  mterest 

292 


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CHAUVINISM  IN  MEDICINE 
taken  in  it  by  that  lar-wghted  and  noble-minded  man, 
Dr  Palmer  Howard— it  would  ill  become  me,  I  say,  not 
to  pay  a  tribute  ol  words  to  Dr.  Roddick  for  the  leal  and 
pewirtence  with  which  he  has  laboured  to  promote  umon 
in  the  compound,  comminuted  fracture  of  the  profession 
of  this  Dominion.    My  feeling  on  the  subject  of  mter- 
national,   intercolonial,   and   interprovincial   registration 
is  this-a  man  who  presents  evidence  of  proper  traming, 
who  U  a  registered  practitioner  in  his  own  councry  and 
who  brings  credentials  of  good  stonding  at  the  t"  ■>«  of 
departure,  should  be  welcomed  as  a  brother,  treated  as 
such  in  any  country,  and  registered  upon  payment  of  the 
usual  fee.    The  ungenerous  treatment  of  English  physi- 
cians in  Switzerland,  France,  ard  Italy,  uid  the  chaotic 
state  of  internecine  warfare  existmg  on  this  contment, 
indicatfl  how  far  a  miserable  Chauvinism  can  corrupt  the 
great  and  gracious  ways  which   should    characterize    a 

liberal  profession.  ,      n       j 

Though  not  germane  to  the  subje-t,  may  I  be  aUowed 
to  refer  to  one  other  point  in  connexion  with  the  State 
Boards-a  misunderstanding,  I  believe,  of  their  func- 
tions.   The  profession  asks  that  the  man  applying  for 
admission  to  its  ranks  shaU  be  of  good  character  and  fit 
to  practise  the  science  and  art  of  medicine.    The  latter 
is  easily  ascertained  if  practical  men  have  the  place  and 
the  equipment  for  practical  examinations.    Many  of  the 
boards  have  not  kept  pace  with  the  times,  and  the  ques- 
tions set  too  cten  show  a  lack  of  appreciation  of  modem 
methods.    This   has,   perhaps,   been   unavoidable  since, 
m  the  appointment  of  examiners,  it  has  not  always  been 
possible  to  select  experts.    The  truth  is,  that  however 

29S 


i 


Ni 


V 


"^1 


!, 


111 
III 


CHAUVINISM  IN  MEDICINE 

well  organized  and  equipped,  the  State  Boards  cannot 
examine  properly  in  the  scientific  branches,  nor  is  there 
need  to  burden  the  students  with  additional  examinations 
in  anatomy,  physiology  and  chemistry.  The  Provincial 
and  State  Boards  have  done  a  great  work  for  medical 
education  on  this  continent,  which  they  would  crown 
and  extend  by  doing  away  at  once  with  all  theoretical 
examinations  and  limiting  the  tests  for  the  license  to  a 
rigid  practical  examination  in  medicine,  surgery,  and 
midwifery,  in  which  all  minor  subjects  could  be  included. 

IV.  PAROCHIALISM  IN  MEDICINE 
Of  the  parochial  and  more  personal  aspects  of  Chau- 
vinism I  hesitate  to  speak  ;  all  of  us,  unwittingly  as  a  rule, 
illustrate  its  varieties.  The  conditions  of  life  which  round 
us  and  bound  us,  whether  in  town  or  country,  in  college 
or  institution,  give  to  the  most  liberal  a  smack  of  parochial- 
ism, just  as  surely  as  we  catch  the  tic  of  tongue  of  the  land 
in  which  we  live.  The  dictum  put  into  the  mouth  of 
Ulysses,  "  I  am  a  part  of  all  that  I  have  met ,"  expresses  the 
truth  of  the  influence  upon  us  of  the  social  environment, 
but  it  is  not  the  whole  truth,  since  the  size  of  the  parish, 
representing  the  number  of  points  of  contact,  is  of  less 
moment  than  the  mental  fibre  of  the  man.  Who  has 
not  known  lives  of  the  greatest  freshness  and  nobility 
ham^  -i'ed  at  every  turn  and  bo\md  in  chains  the  most 
commonplace  and  sordid,  lives  which  illustrate  the  liberty 
and  freedom  enjoyed  by  minds  innocent  and  quiet,  in 
spite  of  stone  walls  and  iron  bars.  On  the  other  hand, 
scan  the  history  of  progress  in  the  profession,  and  men 
the  most  illiberal  and  narrow,  reeking  of  the  most  perni- 

294 


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CHAUVINISM  IN  MEDICINE 

cioTifl  type  of  Chauvinism,  have  been  among  the  teachers 
and  practitioners  in  the  large  cities  and  great  medical 
centres ;  so  true  is  it,  that  the  mind  is  its  own  place  and  in 
itself  can  make  a  man  independent  of  his  environment. 

There  are  shades  and  varieties  which  are  by  no  means 
offensive.    Many  excellent  features  in  a  man's  character 
may  partake  of  its  nature.    What,  for  example,  is  more 
proper  than  the  pride  which  we  feel  in  our  teachers,  m  the 
university  from  which  we  have  graduated,  in  the  hospital 
at  which  we  have  been  tramed  ?    He  is  a  "  poor  sort " 
who  is  free  from  such  feelings,  which  only  manifest  a 
proper  loyalty.     But  it  easUy  degenerates  into  a  base 
intolerance  which  looks  with  disdain  on  men  of  other 
schools  and  other  ways.    The  pride,  too,  may  be  in  in- 
verse proportion  to  the  justness  of  the  claims.    There   is 
plenty  of  room  for  honest  and  friendly  rivaby  between 
schools  and  hospitals,  only  a  bUnd  Chauvinism  puts  a 
man  into  a  hostile  and  intolerant  attitude  of  mind  at  the 
mention  of  a  name.    Alumni  and  friends  should  remember 
that    indiscriminate  praise  of  institutions  or  men  is  apt 
to  rouse  the  frame  of  mmd  iUustrated  by  the  ignore  nt 
Athenian  who,  so  weary  of  hearing  Aristides  always  called 
the  Just,  very  gladly  took  up  the  oyster  shell  for  his  os- 
tracism, and  even  asked  Aristides  himself,  whom  he  did 
not  know,  to  mark  it. 

A  common  type  of  collegiate  Chauvinism  is  manifest 
in  the  narrow  spirit  too  often  displayed  in  filling  appoint- 
ments. The  professoriate  of  the  profession,  the  most 
mobUe  column  of  its  great  army,  should  be  recruited  with 
the  most  zealous  regard  to  fitness,  irrespective  of  local 
conditions  that  are  apt  to  influence  the  selection.    In- 

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CHAUVINISM  IN  MEDICINE 

breeding  is  as  hurtful  to  colleges  as  to  cattle.  The  inter- 
change of  men,  particularly  of  young  men,  is  most  stim- 
ulating, and  the  complete  emancipation  of  the  chairs  which 
has  taken  place  in  most  of  our  universities  should  extend 
to  the  medical  schools.  Nothing,  nerhaps,  has  done  more 
to  place  German  medicine  in  the  lorefront  to-day  than  a 
peripatetic  professoriate,  owing  allegiance  only  to  the 
profession  at  large,  regardless  of  civic,  sometimes,  indeed, 
of  national  limitations  and  restrictions.  We  acknowledge 
the  principle  in  the  case  of  the  scientific  chairs,  and  with 
increasing  frequency  act  upon  it,  but  an  attempt  to  ex- 
pand it  to  other  chairs  may  be  the  signal  for  the  display 
of  rank  parochialism. 

Another  unpleasant  manifestation  of  collegiate  Chau- 
vinism is  the  outcome,  perhaps,  of  the  very  keen  com- 
petition which  at  present  exists  in  scientific  circles.  In- 
stead of  a  generous  appreciation  of  the  work  done  in  other 
places,  there  is  a  settled  hostility  and  a  narrowness  of 
judgment  but  little  in  keeping  with  the  true  spirit  of 
science.  Worse  still  is  the  "  lock  and  key  "  laboratory  in 
which  suspicion  and  distrust  reign,  and  everyone  is  jealous 
and  fearfiil  lest  the  other  should  know  of  or  find  out  about 
his  work.  Thank  God !  this  base  and  bastard  spirit  is 
not  much  seen,  but  it  is  about,  and  I  would  earnestly 
entreat  any  young  man  who  unwittingly  finds  himself  in  a 
laboratory  pervaded  with  this  atmosphere,  to  get  out  ere 
the  contagion  sinks  into  his  soul. 

Chauvinism  in  the  unit,  in  the  general  practitioner,  is  of 
much  more  interest  and  importance.  It  is  amusing  to 
read  and  hear  of  the  passing  of  the  family  physician. 
There  never  was  a  time  in  our  history  in  which  he  was  so 

296 


CHAUVINISM  IN  MEDICINE 
much  in  evidence,  in  which  he  was  so  prosperous,  in  which 
his  prospects  were  so  good  or  his  power  in  the  community 
80  potent.    The  public  has  even  begun  to  get  aentmiental 
over  him !    He  stiU  does  the  work ;  the  consultants  and 
the  specialists  do  the  talking  and  the  writing ;  and  take 
the  fees !    By  the  work,  I  mean  that  great  mass  of  routme 
practice  which  brings  the  doctor  into  every  household 
in  the  land  and  makes  him,  not  alone  the  adviser,  but  the 
valued  friend.    He  is  the  standard  by  which  we  are  mea- 
sured. What  he  is,  we  are ;  and  the  estimate  of  the  pro- 
fession in  the  eyes  of  the  public  is  their  estimat«.  of  him. 
A  weU-trained.  sensible  doctor  is  one  of  the  most  valuable 
assets  of  a  community,  worth  to-day,  as  in  Homer's  time, 
many  another  man.    To  make  him  efficient  is  our  highest 
ambition  as  teachers,  to  save  him  from  evil  should  be  oux- 
constant  care  as  a  guild.    I  can  only  refer  here  to  certam 
aspects  in  which  he  is  apt  to  show  a  narrow  Chauvinism 
hurtful  to  himself  and  to  us. 

In  no  single  relation  of  life  does  the  general  practitioner 
Bhow  a  more  Uliberal  spirit  than  in  the  treatment  of  him- 
self     I  do  not  refer  so  much  to  careless  habits  of  Uvmg, 
to  lack  of  routine  in  work,  or  to  faUure  to  pay  due  atten- 
tion to  the  business  side  of  the  profession-sins  which  so 
easUy  beset  him-but  I  would  speak  of  his  failure  to  realize 
first,  the  need  of  a  Ufelong  progressive  personal  traimng, 
and  secondly,  the  danger  lest  in  the  stress  of  practice  he 
sacrifice  that  most  precious  of  all  possessions,  his  mental 
independence.    Medicine  is  a  most  difficult  art  to  ac- 
quire.   AU  the  college  can  do  is  to  teach  the  student 
principles,  based  on  facts  in  science,  and  give  him  good 
methods  of  work.  These  simply  start  him  in  the  right  direc- 

297 


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CHADVnnSM  IN  MEDICINE 


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tion,  they  do  not  make  him  a  good  practitioner— that  is  his 
own  a£bir.  To  master  the  art  requires  sustained  e£Eort, 
like  the  bird's  flight  which  depends  on  the  incessant  action 
of  the  wings,  but  this  sustained  efiort  is  so  hard  that  many 
give  up  the  struggle  in  despair.  And  yet  it  is  only  by 
persistent  intelligent  study  of  disease  upon  a  methodical 
plan  of  examination  that  a  man  gradually  learns  to  corre- 
late his  daily  lessons  with  the  facts  of  his  previous  experi- 
ence and  of  that  of  his  fellows,  and  so  acquires  clinical 
wisdom.  Nowadays  it  is  really  not  a  hard  matter  for  a 
well-trained  man  to  keep  abreast  of  the  best  work  of  the 
day.  He  need  not  be  very  scientific  so  long  as  he  has  a 
true  appreciation  of  the  dependence  of  his  art  on  science, 
for,  in  a  way,  it  is  true  that  a  good  doctor  may  have  prac- 
tice and  no  theory,  art  and  no  science.  To  keep  up  a 
familiarity  with  the  use  of  instruments  of  precision  is  an 
all-important  help  in  his  art,  and  I  am  profoundly  con- 
vinced that  as  much  space  should  be  given  to  the  clinical 
laboratory  as  to  the  dispensary.  One  great  difficulty  is 
that  while  waiting  for  the  years  to  bring  the  inevitable 
yoke,  a  young  fellow  gets  stale  and  loses  that  practised 
familiarity  with  technique  whirh  gives  confidence.  I 
wish  the  older  practitioners  would  remember  how  im- 
portant it  is  to  encourage  and  utilize  the  young  men  who 
settle  near  them.  In  every  large  practice  there  are  a 
dozen  or  more  cases  requiring  skilled  aid  in  the  diagnosis, 
and  this  the  general  practitioner  can  have  at  hand.  It  is 
his  duty  to  avail  hims«>lf  of  it,  and  failing  to  do  so  he  acts 
in  a  most  illiberal  and  unjust  w^v  to  himself  and  to  the 
profession  at  large.  Not  only  may  the  older  man,  if  he 
has  soft  arteries  in  his  grey  cortex,  pick  up  many  points 

298 


1^.1. 


CHAUVINISM  IN  MEDICINE 
from  the  young  feUow,  but  there  ia  much  clinical  wisdom 
afloat  in  each  parish  which  is  now  wasted  or  dies  with  the 
old  doctor,  because  he  and  the  young  men  have  never 
been  on  friendly  terms. 

In  the  fight  which  we  have  to  wage  incessantly  against 
ignorance  and  quackery  among  the  masses  and  foUies  of  all 
sorts  among  the  classes,  diagnosia,  not  drugging,  is  our 
chief  weapon  of  offence.  Lack  of  systematic  personal 
training  in  the  methods  of  the  recognition  of  disease  leads 
to  the  misapplication  of  remedies,  to  long  courses  of  treat- 
ment when  treatment  is  useless,  and  so  direcUy  to  that  lack 
of  confidence  in  our  methods  which  is  apt  to  place  us  in  the 
eyes  of  the  public  on  a  levd  with  empirics  <   d  quacks. 

Few  men  live  lives  of  more  devot         If-sacrifice  than 
the  famUy  physician,  but  he  may  bee    .le  so  completely 
absorbed  in  work  that  leisure  is  unknown ;  he  has  scarce 
time  to  eat  or  to  sleep,  and,  as  Dr.  Drummond  remarks 
in  one  of  his  poems,  "  He's  the  only  man,  I  know  me,  don't 
get  no  holiday."    There  is  danger  in  this  treadmill  life 
lest  he  lose  more  than  health  and  time  and  rest— his  in- 
teUectual  independence.    More  than  most  men  he  feels 
the  trapp'^y  of  isolation— that  inner  isolation  so  well  ex- 
presse'         Alatthew  Arnold's  Ime  "We  mortal  miUions 
live  oL  Even  in  ■   pulous  districts  the  practice  of 

medicine  is  a  lonely  road  which  wincls  up-hiU  aU  the  way 
and  a  man  may  easUy  go  astray  and  never  reach  the  De- 
lectable Mountains  unless  he  early  finds  those  shepherd 
guides  of  whom  Bunyan  tells,  Knowledge,  Experience, 
Watchful,  and  Sincere.  The  circumstances  of  life  mould 
him  into  a  masterful,  self-confident,  self-centered  man, 
whose  worst  faults  often  partake  of  his  best  qualities.    The 

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CHAUVINISM  IN  MEDICINE 

peril  is  that  should  he  cease  to  think  for  himself  he  becomes 
a  mere  automaton,  doing  a  penny-in'the-slot  business 
which  places  him  on  a  level  with  the  chemist's  clerk  who 
can  hand  out  specifics  for  every  Ul,  from  the  "  pip  "  to  the 
pox.  The  salt  of  life  in  him  is  a  judicious  scepticism, 
not  the  coarse,  crude  form,  but  the  sober  sense  of  honest 
doubt  eicpressed  in  the  maxim  of  the  sly  old  Sicilian  Epi- 
charmus,  "  Be  sober  and  distrustful ;  these  are  the  sinews 
of  the  understanding."  A  great  advantage,  too,  of  a 
sceptical  attitude  of  mind  is,  as  Green  the  historian  re- 
marks, "  One  is  never  very  surprised  or  angry  to  find  that 
one's  opponents  are  in  the  right."  It  may  keep  him 
from  self-deception  and  from  falling  into  that  medical 
slumber  into  which  so  many  drop,  deep  as  the  theological 
slumber  so  lashed  by  Erasmus,  in  which  a  man  may  write 
letters,  debauch  himself,  get  drunk,  and  even  make  money 
— a  slumber  so  deep  at  times  that  no  torpedo-touch  can 
waken  him. 

It  may  keep  the  practitioner  out  of  the  clutches  of  the 
arch  enemy  of  his  professional  independence — the  perni- 
cious literature  of  our  camp-followers,  a  literature  in- 
creasing in  bulk,  in  meretricious  attractiveness,  and  in 
impudent  audacity.  To  modern  pharmacy  we  owe  much, 
and  to  pharmaceutical  methods  we  shall  owe  much  more 
in  the  future,  but  the  profession  has  no  more  insidious 
foe  than  the  large  borderland  pharmaceutical  houses.  No 
longer  an  honoured  messmate,  pharmacy  in  this  form 
threatens  to  become  a  huge  parasite,  eating  the  vitals  of 
the  body  medical.  We  all  know  only  too  well  the  bastard 
literature  which  floods  the  mail,  every  page  of  which  illus- 
trate»  the  truth  of  the  axiom,  the  greater  the  ignorance 

800 


-^-'      * 


CHAUVINISM  IN  MEDICINE 

the  greater  the  dogmatism.    Much  of  it  U  advertisements 
of  nostrums  foisted  on  the  profession  by  men  who  trade 
on  the  innocent  credulity  of  the  regular  physician,  quite 
as  much  as  any  quack  preys  on  the  gullible  public.    Even 
the  most  respectable  houses  are  not  free  from  this  sm  of 
arrogance  and  of  ignorant  dogmatism  m  their  literature. 
A  still  more  dangerous  enemy  to  the  mental  virility  of  the 
general  practitioner,  is  the  "  drummer  "  of  the  drug  house. 
While  many  of  them  are  good,  sensible  feUows,  there  are 
others,  voluble  as  Cassio,  impudent  as  Autolycus,  and  sense- 
less as  Caliban,  who  wUl  tell  you  glibly  of  the  virtues  of 
extract  of  the  coccygeal  gland  in  promoting  pmeal  meta- 
boUsm,  and  are  ready  to  express  the  mo^    emphatic  opm- 
ions  on  questions  about  which  the  greatest  masters  of  our 
art  are  doubtful.    No  class  of  men  with  which  we  have 
to  deal  illustrates  more  fuUy  that  greatest  of  ignorance- 
the  ignorance  vhich  is  the  conceit  that  a  man  knows  what 
he  does  not  know  ;  but  the  enthralment  of  the  practitioner 
by  the  manufacturing  chemist  and  the  revival  of  a  pseudo- 
scientific  polypharmacy  are  too  large  questions  to  be  dealt 
with  at  the  end  of  an  address. 

But  there  is  a  still  greater  sacrifice  which  many  of  us 
make,  heedlessly  and  thoughtlessly  forgetting  that  "  Man 
does  not  live  by  bread  alone.    One  cannot  practise  medi- 
cine alone  and  practise  it  early  and  late,  as  so  many  of  us 
have  to  do,  and  hope  to  escape  the  maUgn  influences  of 
a  routine   life.     The  incessant  concentration  of  thought 
upon  one  subject,  however  interesting,  tethers  a  man's 
mmd  in  a  narrow  field.      The  practitioner  needs  culture 
as  weU  as  learning.  The  earliest  picture  we  have  m  lite- 
rature of  a  scientific  physician,  in  our  sense  of  the  term, 

801 


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i  ! 


CHAUVINISM  IN  MEDICINE 

IB  as  a  otdtared  Qreek  gentleman ;  and  I  care  not  whether 
the  young  man  labours  among  the  beautiful  homes  on 
Sherbrooke  Street,  or  in  the  slums  of  Caughnawauga,  or 
in  some  sparsely  settled  country  district,  he  cannot  afford 
to  have  learning  only.  In  no  profession  does  culture  count 
for  so  much  as  in  medicine,  and  no  man  needs  it  more  than 
the  general  practitioner,  working  among  all  sorts  and 
conditions  of  men,  many  of  whom  are  influenced  quite 
as  much  by  his  general  ability,  which  thty  can  appreciate, 
as  by  his  learning  of  which  they  have  no  measure.  The 
day  has  passed  for  the  "  practiser  of  physic  "  to  be  like 
Mr.  Robert  Levet,  Dr.  Johnson's  friend,  "  Obscurely  wise 
and  coarsely  kind."  The  wider  and  freer  a  man's  general 
education  the  better  practitioner  is  he  likely  to  be,  parti- 
cularly among  the  higher  classes  to  whom  the  reassurance 
and  sympathy  of  a  cultivated  gentleman  of  the  tj^je  of 
Eryzimachus,  may  mean  much  more  than  pills  and  po- 
tions. But  what  of  the  men  of  the  type  of  Mr.  Robert 
Levet,  or  "Ole  Docteur  Fiset,"  whose  virtues  walk  a 
narrow  round,  the  men  who  do  the  hard  general  practices 
in  the  poorer  districts  of  the  large  cities,  in  the  factory 
towns  and  in  the  widely  scattered  rough  agricultural  re- 
gionc  —what,  I  hear  you  say.  has  culture  to  do  with  them  ? 
Everything !  It  is  the  bichloride  which  may  prevent  the 
mfection  and  may  keep  a  man  sweet  and  whole  amid  the 
most  debasing  surroundings.  Of  very  little  direct  value 
to  him  in  his  practice — though  the  poor  have  a  pretty 
keen  appreciation  of  a  gentleman — it  may  serve  to  pre- 
vent the  degeneration  so  apt  to  overtake  the  overworked 
practitioner,  whose  nature  is  only  too  prone  to  be  subdued 
like  the  dyer's  hand  to  what  it  works  in.    If  a  man  does 

802 


CHAUVINISM  IN  MEDICINE 

not  sell  his  soul,  if  he  does  not  part  with  his  birthright  of 
independence  for  a  mess  of  pottage  to  the  Ishmaelites  who 
harass  our  borders  with  their  clubs  and  oppress  us  with 
their  exactions,  if  he  can  only  keep  free,  the  conditions 
of  practice  are  nowhere  incompatible  with  St.  Paul's 
noble  Christian  or  Aristotle's  true  gentleman  (Sir  Thomas 
Browne). 

Whether  a  man  will  treat  his  professional  brethren  in  a 
gentlemanly  way  c.  in  a  narrow  illiberal  spirit  is  partly 
a  matter  oi  temperament,  partly  a  matter  of  traming. 
If  we  had  only  to  deal  with  one  another  the  difficulties 
would  be  slight,  but  it  must  be  confessed  that  the  practice 
of  medicine  among  our  fellow  creatures  is  often  a  testy 
and  choleric  business.    When  one  has  done  his  best  or 
when  a  mistake  has  arisen  through  lack  of  special  know- 
ledge, but  more  particularly  when,  as  so  often  happens, 
our  heart's  best  sympathies  have  been  engaged,  to  be  mis- 
understood by  the  patient  and  his  friends,  to  have  evil 
motives  imputed  and  to  be  maligned,  is  too  much  for 
human  endurance  and  justifies  a  righteous  indignation. 
Women,  our  greatest  friends  and  our  greatest  enemies, 
are  the  chief  sinners,  and  while  one  will  exhaust  the  re- 
sources of  the  language  in  describing  our  mistakes  and 
weaknesses,  another  will  laud  her  pet  doctor  so  indiscrimin- 
ately that  all  others  come  under  a  sort  of  oblique  con- 
demnation.   "  Foeminae  simt  medicorum  tubse  "  is  an  old 
and  true  saying.    It  is  hard  to  say  whether  as  a  whole 
we  do  not  suffer  just  as  much  from  the  indiscriminate 
praise.    But  against  this  evil  we  are  helpless.    Fai    ther- 
wise,  when  we  do  not  let  the  heard  word  die  ;  not  to  listen 
is  best,  though  that  is  ncft  always  possible,  but  silence 

303 


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f  1    fr 


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CHAUVINISM  IN   BIEDICINB 

is  always  poasible,  than  which  we  have  no  better  weapon 
in  otir  armoury  against  evil-speaking,  lying,  and  slander- 
mg.    The  bitterness  is  when  the  tale  is  believed  and  a 
brother's  good  name  is  involved.    Then  begins  the  worst 
form  of  ill-treatment  that  the  practitioner  receives— and 
at  his  own  hands !    He  allows  the  demon  of  resentment 
to  take  possession  of  his  soul,  when  five  minutes'  frank 
conversation  might  have  gained  a  brother.    In  a  small 
or  a  large  community  what  more  io3rful  than  to  see  the 
brethren  dwelling  together  in  unity.    The  bitterness,  the 
rancour,  the  personal  hostility  which  many  of  us  remember 
in  our  younger  days  has  been  largely  replaced  by  a  better 
feeling  and  while  the  golden  rule  is  not  always,  as  it 
should  be,  our  code  of  ethics,  we  have  certainly  become 
more  charitable  the  one  towards  the  other. 

To  the  senior  man  in  our  ranks  we  look  for  an  example, 
and  m  the  smaller  towns  and  country  districts  if  he  would 
remember  that  it  is  his  duty  to  receive  and  welcome  the 
young  fellow  who  settles  near  him,  that  he  should  be  willing 
to  act  as  his  adviser  and  refuse  to  regard  him  as  a  ri  al, 
he  may  make  a  good  friend  and  perhaps  gain  a  brother. 
In  speaking  of  professional  harmony,  it  is  hard  to  avoid 
the  trite  and  commonplace,  but  neglecting  the  stale  old 
chaps  whose  ways  ire  set  and  addressing  the  young,  to 
whom  sympathy  and  encouragement  are  so  dear,  and 
whose  way  of  life  means  so  much  to  the  profession  we 
love,  upon  them  I  would  urge  the  practice  of  St.  Augus- 
tine, of  whom  it  is  told  in  the  Golden  Legend  that  "  he  had 
these  verses  written  at  his  table  : 

Quisquis  amat  dictis  abcsentum  rodere  vitam, 
Hanc  mensam  indignam  noverit  esse  sibi  * 
304 


CHAUVINISM  IN  MEDiaNE 

That  is  to  My :  Whosoever  'oves  to  missay  any  creature 
that  is  absent,  't  may  be  said  that  this  teble  is  deniad  to 

him  at  all." 

With    our    History,    Traditions,    Achievements,    and 
Hopes,  there  is  little  room  for  Chauvinism  in  medicine. 
The  open  mind,  the  free  spirit  of  science,  the  ready  accept- 
ance of  the  best  from  any  and  every  source,  the  attitude 
of  rational  receptiveness  rather  than  of  antagonism  to  new 
ideas,  the  liberal  and  friendly  relationship  between  dif- 
ferent nations  and  different  sections  of  the  same  nation, 
the  brotherly  feeling  which  should  characterize  members 
of  the  oldest,  most  beneficent  and  universal  guild  that 
the  race  has  evolved  in  its  upward  progress— these  should 
neutralize  the  tendencies  upon  which  I  have  so  lightly 

touched. 

I  hegan  by  speaking  of  the  art  of  detachment  as  that 
rare  i.id  precious  quality  demanded  of  one  who  wished 
to  take  a  philosophical  view  of  the  profession  as  a  whole. 
In  another  way  and  in  another  sense  this  art  may  be  still 
more  precious.    There  is  possible  to  each  one  of  us  a  higher 
type  of  intellectual  detachment,  a  sort  of  separation  from 
the  vegetative  Ufe  of  the  work-a-day  world— always  too 
much  with  us— which  may  enable  a  man  to  gain  a  true 
knowledg    oi  himself  and  of  his  relations  to  his  fellows. 
Once  attained,  self-deception  is  impossible,  and  he  may 
see  himself  even  as  he  is  seen— not  always  as  he  would 
like  to  be  seen— and  his  own  deeds  and  the  deeds  of  others 
stand  out  in  their  true  light.    In  such  an  atmosphere  pity 
for  himself  h  so  commingled  with  sympathy  and  love 
for  others  that  thexe  is  no  place  left  for  criticism  or  for  a 
harsh  judgment  of  his  brother.    But  as  Sir  Thomas  Browne 


'I 


M     ' 


AK. 


305 


11   ' 


M 


'■I 


i»'P 


'i 


CHAUVINISM  IN  IfEDICINE 

— mott  liberal  of  men  and  most  dutinguished  oi  general 
praotitionen— «o  beaatiially  remarks :  "  These  are  Thonghte 
of  things  which  Thoughts  but  tenderly  touch,'*  and  it 
may  be  sufficient  to  remind  this  audience,  made  up  of 
practical  men.  that  the  word  of  aoUon  w  itronger  than  the 
vnrd  of  $feeoh. 


30e 


XV 


SOME  ASPECTS  OF  AMERICAN 
MEDICAL  BIBLIOGRAPHY 


307 


'I 


\  I 


i 

I. 

i.  i 


J  i 


^PJ 


h 


Li 


Without  History  a  man's  soul  is  purblind,  seeing  only  the  things 
which  almost  touch  his  eyes. 

Fuller,  Holy  and  Profane  State,  1642. 

Every  physician  will  make,  and  ought  to  make,  observations 
from  his  own  experience ;  but  he  will  be  able  to  make  a  better 
judgment  and  juster  observations  by  comparing  what  he  reads 
and  what  he  sees  together.  It  is  neither  an  affront  to  any  man's 
understanding,  nor  a  cramp  to  his  genius,  to  say  that  both  the  one 
and  the  other  may  be  usefully  employed,  and  happily  improved 
in  searching  and  examining  into  the  opinions  and  methods  of 
those  who  lived  before  him,  especially  considering  that  no  one 
is  tied  up  from  judging  for  himself,  or  obliged  to  give  into  the 
notions  of  any  author,  any  further  than  he  finds  them  agreeable 
to  reason,  and  reducible  to  practice.  No  one  therefore  need  fear 
that  his  natural  sagacity,  whatever  it  is,  should  be  perplexed  or 
misled  by  reading.  For  there  is  as  large  and  fruitful  a  field  for 
sagawity  and  good  judgment  to  display  themselves  in,  by  dis- 
tinguishing between  one  author  and  another,  and  sometimes  be- 
tween the  several  parts  and  passages  in  the  same  author,  as  is  to 
be  found  in  the  greatest  extent  and  variety  of  practice.  ...  It 
has  not  usually  been  looked  upon  as  an  extraordinary  mark  of 
wisdom  for  a  man  to  think  himself  too  wise  to  be  taught;  and 
yet  this  seems  to  be  the  case  of  those  who  rely  wholly  upon  their 
own  experience,  and  despise  all  teachers  but  themselves. 

FwENO,  Hittory  of  Physic,  Volume  I. 


1^ 


808 


K,'  5 


XV 


SOME  ASPECTS  OF  AMERICAN 
MEDICAL  BIBLIOGRAPHY' 

I 

IN  conferring  upon  me  the  presidency  of  this  Association, 
I  felt  that  you  wished  to  pay  a  compliment  to  a  man 
who  had  been  much  helped  by  libraries  and  who  knew 
their  value,  and  I  hoped  that  it  was,  perhaps,  in  recogni- 
tion of  the  fact  that  a  practical  and  busy  physician  may 
be  at  the  same  time  a  book  lover,  even  a  book  worm. 

You  are  familiar,  of  course,  with  the  objects  of  this 
Association,  but  as  there  are  present  with  us  also  those 
who  are  not  members,  this  is  an  occasion  in  which  a  little 
missionary  work  is  timely,  and  I  may  briefly  refer  to  some 
of  them.  An  association  of  the  medical  libraries  of  the 
country,  our  membership  includes  both  the  great  libraries^ 
with  50,000-100,000  volumes,  and  the  small  collections 
just  started  of  a  few  hundred  books.  The  former  gain 
nothing  directly  from  an  affiliation  with  us— they  give 
more  than  they  get,  but  the  blessing  that  goes  with  this 
attitude  is  not  to  be  despised,  and  from  their  representa- 
tives we  look  for  guidance  and  advice.    Please  understand 

1  Asaociation  of  Medical  Librarians,  1902. 
309 


ill' 

i 


[■I 


ni,;. 


i 


i« 


I 


.  r. 


i..'l 


r,      ;    , 


i  ; 


V  H      ! 


iM. 


SOME  ASPECTS  OF  AMERICAN 

that  in  this  address  I  am  not  talking  to  the  men  in  charge 
of  them  who  are  familiar  with  what  I  shall  say,  and  who 
are  experts  where  I  am  only  a  dabbler ;  but  I  wish  to 
catch  the  inexperienced,  those  in  charge  of  the  small  but 
growing  libraries,  upon  whom  I  wish  to  impress  some 
wider  aspects  o*  the  work.  In  the  recent  history  of  the 
profession  ther<'  is  nothii^  more  encouraging  than  the 
increase  in  the  nnnber  of  medical  libraries.  The  organi- 
zation of  a  library  means  effort,  it  means  union,  it  means 
progress.  It  does  good  to  men  who  start  it,  who  help 
with  money,  with  time  and  with  the  gifts  of  books.  It 
does  good  to  the  young  men,  with  whom  our  hopes  rest, 
and  a  library  gradually  and  insensibly  moulds  the  profession 
of  a  town  to  a  better  and  higher  status. 

We  trust  that  this  Association  may  be  a  medium  through 
which  men  interested  in  the  promotion  of  the  welfare  of  the 
profession  may  do  much  good  in  a  quiet  way.  We  have 
to  thank  some  twenty  physicians  who  have  kindly  joined 
us  in  this  work  and  whose  subscriptions  help  to  pay  the 
expenses  of  our  exchange ;  but  their  names  on  our  list 
do  more— it  is  an  encouragement  to  know  that  they  are 
with  us,  and  as  they  get  nothing  in  return  (except  the 
Bulletin)  they  should  know  how  much  we  appreciate 
their  fellowship.  We  have  to  thank,  in  particular,  many 
editors  who  send  us  their  journals  for  distribution,  and  the 
editors  of  many  Transactions.  The  liberality  with  which 
the  work  of  our  Exchange  has  been  aided  by  the  large 
libraries  is  beyond  all  praise.  Time  and  again  the  Library 
of  the  Surgeon-General's  Office,  the  Academy  of  Medicine 
of  New  York,  the  Boston  Medical  Library  Association, 
and  the  College  of  Physicians'  Library  of  Philadelphia  have 

810 


MEDICAL  BIBLIOGRAPHY 

fiUed  long  lists  of  wants  for  smaUer  libraries.  The  pro- 
fession is  deeply  indebted  to  Drs.  Merrill,  Chadwick.  and 
Brigham.  to  Mr.  Browne  and  to  Mr.  C.  P.  Fisher  for  their 
disinterested  labours.  In  some  details  our  machmery 
could  be  better  adjusted,  but  we  have  had  to  work  with 
very  little  money,  which  means  sUght  clerical  help  where 
much  is  needed,  but  with  an  increasing  membership  we 
can  look  forward  confidently  to  a  much  more  complete 
organization  ar  •      a  wider  field  of  usefulness. 

But  this  Ah  Jn  may  have  other  ambitions  and 

hopes.    We  des^e  to  foster  among  our  members  and  in 
the  profession  at  large  a  proper  love  of  books.    For  its  own 
sake  and  for  the  sake  of  what  it  brings,  medical  biblio- 
graphy is  worthy  of  a  closer  study  than  it  has  received 
heretofore  in  this  country.    The  subject  presents  three 
aspects,  the  book  itself,  the  book  as  a  literary  record, 
i  e    its  contents,  and  the  book  in  relation  to  the  author 
Strictly   speaking,    bibliography    means   the   science    of 
everythmg  relating  to  the  book  itself,  and  has  nothing  to 
do  with  its  contents.    In  the  words  of  a  recent  writer,  the 
bibliographer  "  has  to  do  with  editions  and  their  pecu- 
liarities, with  places,  printers,  and  dates,  with  types  and 
Ulustrations,  with  sizes  and  collations,  with  bindings  and 
owners,  with  classifications,  collections,  and  catalogues. 
It  is  the  book  as  .   -naterUl  object  in  the  world  that  is 
his  care,  not  the  instruction  of  which  it  may  be.  or  may 
faU  to  be.  the  vehicle.    BibUography  is  the  science  or  the 
art.  or  both,  of  book  description."  * 
But  there  is  a  larger  sense  of  the  word,  and  I  shall  discuss 


Professor  Ferguson.  Some  Aspects  of  BiUiography,  Edinburgh, 


1    a 


1900. 


811 


V  I 


u 
i< 


<  r 


f 


11    i 


V 

■     ; 


SOME   ASPECTS   OF   AMERICAN 

some  aspects  of  Amercan  medical  bibliography  in  the  three- 
fold relationship  to  which  I  have  referred. 

II 

.ae  typographical  considerations  may  be  passed  over 
with  a  few  words.  We  have  no  Aldus  or  Froben  or 
Stephanus  or  Ekevir,  whose  books  are  sought  and  prized 
for  them.^elves,  irrespective  of  their  contents.  With  few 
exceptions  the  medical  works  published  here  at  the  end  of 
the  eighteenth  and  the  beginning  of  the  nineteenth  cen- 
turies were  poor  specimens  of  the  printer's  art.  Compare 
a  Sydenham  lirst  edition  of  1682  with  Caldwell's  Cullen, 
issued  in  Philadelphia  more  than  100  years  later,  and  the 
comparison  is  in  favour  of  the  former ;  and  yet  there  is 
much  of  bibliographical  interest  in  early  American  publica- 
tions. It  would  make  an  instructive  exhibit  to  take  a 
series  of  surgical  books  issued  in  this  country  from  Jones' 
Manual  in  1776  to  KMy's  Operative  Gynecology ;  it  would 
illustrate  the  progress  in  the  art  of  book  making,  and 
while  there  would  be  nothing  striking  or  original,  such 
volumes  as  Dorsey'd  Elements  of  Surgery  (1813),  particularly 
in  the  matter  of  illustrations,  would  show  that  there 
were  good  book  makers  at  that  date.  At  one  of  the 
meetings  of  the  American  Medical  Association  i,  selection 
of  the  works  issued  during  the  117  years  of  the  existence 
of  the  house  of  Lea  Brothers  would  form  an  instructive 
exhibition.  There  are  few  medical  works  in  this  country 
the  genealogy  of  which  requires  any  long  search.  Other 
than  the  "  Code  of  Ethics  "  of  the  American  Medical  Associa- 
tion and  the  "  American  Pharmacopeia,"  both  of  which, 
by  the  way,  have  histories  worth  tracking,  and  the  "  Dis- 

812 


MEDICAL  BIBLIOGRAPHY 

pensatory"  of  Wood  and  Bache,  I  know  of  no  wor^s 
fifty  years  old  which  continue  to  be  reprinted.    Compared 
with  the  text-books,  etc.,  the  journals  of  the  early  days 
were  more  presentable,  and  the  general  appearance  of  such 
publications  as  the  Medical  Repository,  of  New  York,  the 
Medical  Museum,  of  Philadelphia,  and  later  the  Medical 
and  Physical  Journal,  the  North  American  Medical  and 
Surgical  Journal  and   the   Medical  Recorder,   not   only 
contrasts  favourably  with  that  of  European  journals  of 
the  period,  but  one  gets  an  impression  of  capable  and 
scholarly  editorial  control  and  a  high  grade  of  origmal 
contribwion.    The  Medical  and  Physical  Journal,  founded 
in  1820,  has  a  special  mterest  and  should  be  put  on  the 
shelves  just  before  the  American  Journal  of  the  Medical 
Sciences,  into  which  it  merged,  one  of  the  few  great  journals 
of  the  world,  and  the  one  from  which  one  can  almost  write 
the  progress  of  American  medicine  during  the  past  century. 
While  there  is  not  in  American  medicine  much  of  pure 
typographical  interest,  a  compensation  is  offered  in  one 
of  the  most  stupendous  bibliographical  works  ever  under- 
taken.    The    Index-Catalogue    of    the    Library  of    the 
Surgeon-General's  Office  atones  for  all   shortcomings,  as 
in  it  is  furnished  to  the  world  a  universal  medical  biblio- 
graphy from  the  earliest  times.    It  will  ever  remain  a 
monument  to  the   Army  Medical   Department,   to  the 
enterprise,  energy  and  care  of  Dr.  Billings,  and  to  the 
scholarship  of  his  associate,  Dr.  Robert  Fletcher.    Ambi- 
tious men  before  Dr.  Billings  had  dreamt  of  a  comprehen- 
sive medical   bibliography.    Conrad  Gesner,  the  learned 
Swiss  naturalist  and  physician,  published  his  BiUiotheca 
Universalis  as  early  as  1545  and  followed  it  in  1548-9 

313 


Ijtt 


!  i 


'     i 


SOME  ASPECTS  OF  AMERICAN 

by  a  supplement  entitled  Pandectarum  sive  Partitionum 
universalium  Conradi  Gesneri,  libri  xxi.    Book  xx,  which 
was  to  represent  the  quintessence  o!  the  labours  oi  his  life 
and  which  was  to  include  the  medical  bibliography,  never 
appeared,  owing  to  his  untimely  yet  happy  death — fdix 
mors  Gesneri,  as  Caius  says,  in  the  touching  tribute  to  his 
friend.*    Merklin,  von  Haller,  Ploucquet,  Haeser,  Young, 
Forbes,  Atkinson  and  others  have  dipped  into  the  vast 
subject,  but  their  efforts  are  Lilliputian  beside  the  Gar- 
gantuan undertaking    of   the    Surgeon-General's  Office. 
One  work  I  cannot  pass  without  a  regret  and  a  reference— 
the  unfinished  medical  bibliography  of  James  Atkinson, 
London,  1834.    If  not  on  your  shelves,  keep  your  eyes 
on  the  London  catalogues  for  it.    It  only  includes  the 
letters  A  and  B,  but  it  is  a  unique  work  by  a  Thelemite, 
a  true  disciple  of  Rabelais.    I  need  not  refer  in  this  audi- 
ence to  the  use  of  the  Index-Catalogue  in  library  work ; 
it  is  also  of  incalculable  value  to  any  one  interested  in  books. 
Let  me  give  an  everyday  illustration.    From  the  library 
of  my  friend,  the  late  Dr.  Rush  Huidekoper,  was  sent 
to  me  a  set  of  very  choice  old  tomes,  among  which  was  a 
handsome  folio  of  the  works  of  du  Laurens,  a  sixteenth 
century  anatomist  and  physician.    I  had  never  heard  of 
him,  but  was  very  much  interested  in  some  of  his  medical 
dissertations.    In  a  few  moments  from  the  Index-Catalogue 
the  whole  bibliography  of  the  man  was  before  me,  the 
dates  of  his  birth  and  death,  the  source  of  his  biography, 
and  where  to  look  for  his  portrait.    It  b  impossible  to 
overestimate  the  boon  which  this  work  is  to  book  lovers. 


»  <7ai»  Opara,  Jebb's  edition. 
814 


■aa 


MEDICAL  BIBLIOGRAPHY 
One  other  point— the  Index  is  not  used  enough  by  students. 
Take  under  the  subject  of  diseases  of  the  heart.    Only  the 
other  day  I  referred  to  a  journal  article  which  had  a  very 
full  bibUography.  and  I  turned  to  Volume  V  in  the  old 
series,  and  to  the  just  issued  Volume  VI  of  the  new  series, 
and  there  was  the  literature  in  full  on  this  subject  and  in 
it  many  articles  which  the  author  had  overlooked.    The 
entire  bibliography  might  have  been  omitted  with  advantage 
from  the  paper  and  simply  a  reference  made  to  the  Index- 
Catalogue.    It  would  be  well  in  future  if  writers  would 
bear  in  mmd  that  on  many  subjects,  particularly  those 
covered  by  the  second  series  of  the  Catalogue,  the  biblio- 
graphy is  very  complete,  and  only  supplementary  refer- 
ences should  be  made  to  the  articles  which  have  appeared 
since  the  volume  of  the  new  series  dealing  with  the  subject 
was  printed. 


t 


III 

The  second  aspect  of  a  book  relates  to  its  contents,  which 
may  have  an  enduring  value  or  which  may  be  of  interest 
only  as  illustrating  a  phase  in  the  piogress  of  knowledge, 
or  the  importance  may  relate  to  the  conditions  under  which 
the  book  appeared. 

It  IS  sad  to  think  how  useless  are  a  majority  of  the  works 
on  our  shelves— the  old  cyclopedias  and  dictionaries,  the 
files  of  defunct  journals,  the  endless  editions  of  text-books 
as  dead  as  the  authors.  Only  a  few  epoch-making  works 
survive.  Editions  of  the  Hippocratic  writings  appear  from 
time  to  time,  and  in  the  revival  of  the  study  of  the  history 
of  medicine  the  writings  of  such  masters  as  Galen  and 
Aretjeus  reappear,  but  the  interest  is  scholastic,  and  amid 

815 


:^l'lt 


^r^ 


I:- 


i\i 


H  ,! 


'n 


I 


l 


1 


,4 


\ 


SOME  ASPECrrS  OF  AMERICAN 

the  multiplicity  of  studies  how  can  we  ask  the  student 
to  make  himself  familiar  with  the  ancients?  We  can, 
however,  approach  the  consideration  of  most  subjects 
from  an  historical  standpoint,  and  the  young  doctor  who 
thinks  that  pathology  began  with  Virchow  gets  about 
the  same  erroneous  notion  as  the  student  who  begins  the 
study  of  American  history  with  the  Declaration  of  Inde- 
pendence. 

Now  among  the  colossal  mass  of  rubbish  on  the  shelves 
there  are  precious  gems  which  should  be  polished  and 
well  set  and  in  every  library  put  out  on  view.  But  let 
me  first  mollify  the  harshness  of  the  expression  just  used. 
The  other  day,  thinking  in  this  way,  I  took  from  a  shelf 
of  old  books  the  first  one  I  touched.  It  was  Currie's 
Historical  Account  of  the  Climalis  and  Diseases  of  the 
VnUed  States  of  America,  published  in  Philadelphia  in 
1792,  I  had  possessed  it  for  years,  but  had  never  before 
looked  into  it.  I  found  the  first  comprehensive  study  on 
climatology  and  epidemiology  made  in  this  country,  one 
which  antedates  by  several  years  Noah  Webster's  work  on 
epidemics.  With  remarkable  industry  Dr.  Currie  collected 
from  correspondents  in  all  parts  of  the  country  informa- 
tion about  the  prevalent  diseases,  and  I  know  of  no  other 
work  from  which  we  can  get  a  first-hand  sketch  from  the 
practitioners  '  emselves  of  the  maladies  prevalent  in  the 
different  States.  Then  T  had  to  look  up  his  possible 
relationship  with  James  Currie,  of  Liverpool,  the  strong 
advocate  of  hydrotherapy,  the  friend  and  editor  of  Bums, 
who  had  had,  I  remember,  interesting  affiliations  with 
Virginia.  At  the  outbreak  of  the  Revolutionary  War 
he  was  employed  as  a  clerk  at  one  of   the  landings  on 

316 


MEDICAL  BIBLIOGRAPHY 

the  James  River,  and  suffered  not  a  little  for  the  Tory 
cause.  His  letters,  given  in  his  Life,  which  are  well  worth 
reading,  give  a  valuable  picture  of  the  period.  The 
American  Currie's  book  at  least  was  not  rubbish  in  1792, 
but  who  will  read  it  now  ?  And  yet  it  is  on  our  shelves 
for  a  purpose.  It  may  not  be  called  for  once  in  five  years  ; 
it  did  a  good  work  in  its  day,  and  the  author  lived  a  life 
of  unselfish  devotion  to  the  profession.  As  a  maker  of 
much  which  in  a  few  years  will  be  rubbish  of  this  kind,  let 
me  take  back  the  harsh  expression. 

But  I  wish  to  refer  particularly  to  certain  treasures  in 
American  bibliography  which  you  should  all  have  on  your 
shelves.    Of  course  the  great  libraries  have  most  of  them, 
and  yet  not  all  have  all  of  them,  but  with  a  little  effort 
they  can  be  picked  up.    Take  that  notable  Discourse 
upon  the  Institution  of  Medical  Schools  in  America,  by 
John  Morgan,  M.D.,  1765.    From  it  dates  the  organiza- 
tion of    medical  colleges  in  this  country,  but    there  is 
much  more  in  this  scholarly  address.    The  introduction 
contains  a  picture  of  the  state  of  practice  in  Philadelphia 
which  is  in  its  way  unique,  and  for  the  first  time  in  the 
history  of  the  profession  in  this  country  Morgan  tried 
to  introduce  what  he  calls  the  regular  mode  of  practismg 
physic,  as  apart  from  the  work  of  the  surgeon  and  apothe- 
cary.   What  interests  us,  too,  is  his  plea  for  the  estab- 
lishment of  a  medical  library.     Listen    to  his  appeal : 
"Perhaps  the  physicians  of  Philadelphia,  touched  with 
generous  sentiments  of  regard  for  the  rising  generation 
and  the  manifest  advantages  accruing   to  the   College 
thereby,  would  spare  some  useful  books  or  contribute 
somewhat  as  a  foundation  on  which  we  might  begin."    The 

317 


1 


SOME  ASPECTS  OF  AMERICAN 
biographical  fragment*  in  the  introduction  show  the 
remarkable  care  with  which  eome  of  the  young  colonial 
physicians  sought  the  best  available  education.  Few 
to-day,  after  a  protracted  apprenticeship,  do  as  did  Morgan, 
epend  five  -^-ars  m  Europe  under  the  most  celebrated 
miSters,  bv  .e  returned  a  distinguished  Fellow  of  the 
Royal  Society  of  London,  and  a  Correspondent  of  the 
Royal  Academy  of  Surgery  in  Paris. 

John  Jones's  Plain,  Practical,  Concise,  Remarlu  on 
the  Treatment  of  Wounds  and  Fractures,  Designed  for  the 
Use  of  Young  Military  and  Naval  Surgeons  in  North 
America,  1776,  was  the  vade  mecum  of  the  young  surgeons 
in  the  Revolutionary  War.  As  the  first  separate  surgical 
treatise  published  in  this  country  it  has  a  distinct  biblio- 
graphical value,  and,  when,  possible,  you  should  put  the 
three  editions  together. 

Samuel  Bard's  study  on  Angina  Suffocativa  (17.1),  or 
diphtheria,  as  it  would  be  now  termed,  is  an  American 
classic  of  the  first  rank.  It  is  difficult  to  get,  but  it  is 
worth  looking  for.  Get,  too,  his  work  on  Midwifery,  1807, 
the  first  published  m  this  country.  An  enterprising 
librarian  wUl  have  all  the  editions  of  such  a  work. 

Thomas  Bond's  Lecture  Introductory  to  the  Study  of 
Clinical  Medicine  at  the  Pennsylvania  Hospital,  1766, 
remamed  m  manuscript  until  printed  in  Vol.  IV  of  the 
North  Anaerican  Medical  Journal,  1827,  a  copy  of  which 
is  not  difficult  to  obtain.  It  is  abo  republished  in  Morton's 
History  of  the  Pennsylvania  Hospital,  and  I  republished  it 
in  the  University  Medical  Magazine  in  1897. 

The  works  of  Rush  should  be  fully  represented  even  in 
the    smaller    libraries.    His    collected    writings    passed 

818 


or 


i 


MEDICAL  BIBLIOGRAPHY 

through  five  editions  and  are  easj  to  get.  Ru«h  "  is  the 
father  not  only  of  American  medicine,  but  of  American 
medical  literature,  the  type  of  a  great  man,  many-sided, 
far-seeing,  full  of  intellect,  and  genius ;  abused  and  vili- 
fied, as  man  hardly  ever  was  before,  by  his  contemporaries, 
professional  and  non-professional ;  misunderstood  by 
his  immediate  successors,  and  unappreciated  by  the 
present  generation,  few  of  whom  know  an3rthing  of  his 
real  character."  I  gladly  quote  this  estimate  of  Rush 
by  S.  D.  Gross.  Owing  to  the  impression  that  he  was 
disloyal  to  Washington,  there  has  arisen  of  late  a  certain 
feeling  of  antagonism  to  his  name.  The  truth  is  he  was  a 
strong  hater,  and,  as  was  common  at  that  period,  a  bitter 
partisan.  I  wish  some  one  would  give  us  the  account  from 
contemporary  letters,  and  from  the  side  of  Rush.  There  is 
an  astonishing  amount  of  bibliographical  interest  in  the 
writings  of  Rush,  and  a  good  story  awaits  the  leisure 
hours  of  some  capa'^i  young  physician.  His  letters  are 
innumerable  and  scattered  m  many  libraries.  I  came 
across  one  the  other  day  {Bulletin  of  the  New  York  Library, 
vol.  I,  No.  8),  dated  July  27,  1803,  in  which,  replying  to 
an  invitation  from  Horatio  Gates,  he  says  pathetically, 
"  A  large  and  expensive  family  chain  me  to  the  pestle  and 
mortar,"  and  in  a  postscript  he  adds  that  as  he  now  con- 
fines his  labours  to  his  patients,  without  trying  to  combat 
ignorance  and  error,  he  is  kindly  tolerated  by  his  fellow- 
citizens. 

Many  early  works  of  great  importance  are  difficult 
to  find,  such  as  Elisha  North  on  spotted  Typhus  or  cere- 
brospinal fever,  1811.  Noah  Webster's  History  of  Epi- 
demics has  a  special  value,  apart  from  its  interest  as  the 

319 


i-\ 


1-  ■  ' 
i 

N    1 


.; 


cl- 

i 


r 


I 


i.  ' 

I' 


SOME  ASPECTS  OF  AMERICAN 

mott  imporUnt  medical  work  written  in  this  country  by 

a  layman. 

The  tracts  on  vaccination  by  Waterhouae— the  American 
Jcnner-should  be  sought  for  carefully.    Try  to  have  a 
copy  of  Nathan  Smith's  A  Practical  Euay  on  Typhous 
Fever  (1824)  to  hand  to  any  young  physician  who  asks 
for  something  good  and  fresh  on  typhoid  fever.    There 
is  a  long  list  of  important  essays  which  you  should  have. 
I  cannot  begin  to  name  them  all,  but  I  may  mention, 
as  an  example,  Jacob  Bigelow  on  Sdf-lmitcd  Diseates, 
1836,  which  is  a  tract  every  senior  student  should  read, 
mark,  learn  and  inwardly  digest.    If  not  obtainable,  his 
Nature  in  Disease,   1859,  contains  it  and  many  other 
essays  of  value.    James  Jackson's   Letters  to  a   Youn^ 
Physician,  1856,  are  still  worth  reading -and  worth  re- 
publishing. 

The  stories  of  the  great  epidemics  offer  material  for  care- 
ful  bibliographical   research.    Matthew   Carey's   graphic 
description  of  the  great  epidemic  of  yellow  fever  in  Phila- 
delphia, whUe  not  so  lifelike  and  briUiant  as  De  Foe's 
great  story  of  the  plague  in  London,  has  the  advantage 
of  the  tale  of  an  eye-witness  and  of  a  brave  man,  one  of 
the  smaU  band  who  rose  above  the  panic  of  those  awful 
days.    It  is  a  classic  of  the  first  rank.    The  Uttle  book, 
by  the  way,  had  a  remarkable  sale.    The  first  edition  is 
dated  November  13,  1793,  the  second,  November  23,  the 
third,  November  30,  and  the  fourth,  January  16,  1794. 
Brockden  Brown's  Arthur  Mervyn,  whUe  it  gives  in  places 
a  vivid  description  of  this  epidemic,  is,  in  comparison, 
disappointing  and  lame,  not  worthy  to  be  placed  on  the 
same  shelf  with  Carey's  remarkable  account. 

320 


MEDICAL  BIBLIOGRAPHT 

Eyen  the  smaller  libn  hould  have  the  works  of  this 
tjjpe.  They  are  nc*^  ha.  ^  get,  if  looked  for  in  the  right 
way.  Early  Aax.-.  jan  works  on  special  subjects  shookl 
be  sought  for.  The  collection  of  works  exhibited  in  the 
section  on  ophthalmology  at  the  meeting  of  the  American 
Medical  Association  shows  in  the  most  instructive  manner 
the  early  publications  on  the  subject  in  this  country. 


IV 

The  third  aspect  of  medical  bibliography  relates  to 
writings  which  have  a  value  to  us  from  our  interest  in 
the  author.  After  all,  the  true  bibliophile  cares  not  so 
much  for  the  book  as  for  the  man  whose  life  and  mind 
are  illustrated  in  it.  There  are  men  of  noble  life  and  high 
character,  every  scrap  of  whose  writings  should  be  precious 
to  us,  and  such  men  are  not  rare.  The  works  are  not 
always  of  any  special  value  to-day,  or  even  of  any  intrinsic 
interest,  but  they  appeal  to  us  through  the  sympathy 
and  even  the  afiection,  stirred  in  us  by  the  story  of  the 
man's  life.  It  is,  I  know,  a  not  uncommon  feeling — 
a  feeling  which  pervades  No.  XXXII  of  Shakespeare's 
Sonnet8  and  is  so  beautifully  expressed  in  the  concluding 
line,  "  Theirs  for  their  style  I'ii  read,  his  for  his  love." 
Such  an  attitude  I  feel  personally  toward  the  literary 
remains  of  John  Morgan,  David  Ramsay,  Daniel  Drake, 
John  D.  Godman,  James  Jackson,  junr.,  Elisha  Bartlett 
and  others 

In  our  libraries  under  John  Morgan,  to  whose  remark- 
able essay  I  have  already  referred,  there  should  be  also 
his  Vindication,  which  gives  the  story  of  the  Army  Medical 
Department  in  the  early  days  of  the  Revolution.    One 

AE.  821  T 


.   ! 


;1 


SOME  ASPECTS  OF  AMERICAN 
of  the  most  famous  names  in  American  medicine  is  David 
Ramsay,  perhaps  the  most  distinguished  pupil  of  Ben- 
jamin Rush,  a  man  of  high  character.  fuU  of  zeal  and 
ambition  and  devoted  to  his  profession,  yet  what  he  has 
left  in  general  Uterature  far  excels  in  importance  his 
medical  writmgs.    The  larger  libraries  should  have  his 
famous  Htttory  of   the  American   Revolution,    1789    his 
Life  of  Washif^n,  and  the  History  of  South  Carolina 
1809     The  memory  of  such  a  man  shoi^d  be  cherished 
among  us.  and  one  way-and  the  best-is  to  put  a  com- 
plete set  of  his  writings  on  our  shelves. 

Another  noble  soul  of  the  same  stamp  was  John  D. 
Godman.  the  tragedy  of  whose  life  and  early  death  has  a 
pathos  unequalled  in  the  annalsof  the  professionof  America. 
Besides  his  anatomical  works,  his  Museum  of  Ammcan 
Natural  History  and  The  Rambles  of  a  Naturalist  should 
be  among  your  treasured  Americana. 

There  is  a  large  literature  in  this  group  illustrating  the 
excursions  of  medical  men  into  pure  literature.    A  com- 
plete set  of  the  writings  of  Oliver  Wendell  Holmes  should 
be  in  every  medical  library.    His  Boylston  prize  essays 
on  Neuralgia,  on  Malanal  Fever,  and  on  Direct  Exipkra- 
tions  can  be  had  bound  m  one  volume.    One  of  his  writings 
is  inestimable,  and  wul  be  remembered  in  the  profession 
as  long.  I  believe,  as  posterity  will  cherish  his  Chambered 
Nautilus  or  the  Last  Leaf.    If  you  can  find  the  ongmal 
pamphlet  on  the  Contagi(mn^s  of  Puerperal  Fever,  a 
reprint  from  the  New  England  Journal  of  Medicine  and 
Surgery,   1843.  have  it  bound  in  crushed  levant- tis 
worthy  of  it.    The  reprint  of  1855  is  more  accessible^ 
FaUing  either  of  these,  get  the  journal  and  cut  out  and 

322 


3? 


MEDICAL  BIBLIOGRAPHY 

bind  the  article.  Semmelweisa,  who  gets  the  credit  for 
introducing  asepsis  in  midwifery,  came  some  years  later. 
Occasionally,  a  well-known  medical  writer  will  dabble  in 
pure  literature,  and  will  sometimes,  as  in  the  case  of  Dr. 
Wier  Mitchell,  attain  a  success  as  remarkable  as  that 
which  he  has  had  in  his  profession.  Put  his  writings  on 
the  shelves— they  illustrate  his  breadth  and  his  strength. 
A  volume  of  poems  may  illustrate  some  strong  man's 
foible.  George  B.  Wood's  epic  poem,  "  First  and  Last," 
and  the  "Eolopoesis"  of  Jacob  Bigelow  illustrate  the 
dangers  which  beset  physicians  who  write  poetry. 

Biography  is  a  department  which  you  will  find  a  very 
attractive  and  a  most  profitable  field  to  cultivate  for  your 
readers.  The  foreign  literature  includes  several  compen- 
hensive  encyclopedias,  but  it  is  not  a  department  very 
well  represented  in  this  country.  It  is  true  that  an  enor- 
mous literature  exists,  chiefly  m  periodicals,  but  the  sort 
of  biography  to  which  I  refer  has  a  threefold  distinction. 
The  subject  is  a  worthy  one,  he  is  dead,  and  the  writer 
has  the  necessaiy  qualifications  for  the  task.  We  possess 
three  notable  works  on  American  medical  biography: 
James  Thacher,  1828 ;  Stephen  W.  Williams,  1846,  and 
Samuel  D.  Gross,  1861,  which  remain  to-day  the  chief 
works  of  reference  to  the  latter  date.  Thacher's  is  a 
remarkable  production  and  for  the  period  a  most  ambitious 
work.  It  has  been  a  common  tap  to  which  writers  have 
gone  for  information  on  the  history  of  medicine  in  this 
country,  and  the  lives  of  the  prominent  physicians  to 
about  1825.  It  is  a  rare  volume  now,  but  worth  its  price, 
and  I  know  of  no  more  fascinating  book,  or  one  more 
difficult  to  put  down,    Even  the  printed  list  of  subscribers 

823 


i'    I 


SOME  ASPECTS  OF  AMERICAN 

-alongone,too-iBmo8tmtere8ting.    Many  of  Thacher's 
best  known  books  come  in  the  third  category,  and  are  of 
value  in  a  medical  library  only  so  far  as  they  illustrate 
the  remarkable  versatiUty  of  the  man.    His  Practice, 
the  first  American  one,  you  will,  of  course,  try  to  get, 
and  you  should  also  U/e  one  of  the  editions  of  his  Jmrnal 
of  the  Reooluiumary  War,  through  which  he  served  with 
pencil,  as  well  as  scalpel,  m  hand.    It  is  a  most  graphic 
account,  and  of  interest  to  us  here  smce  he  describes  very 
fully  the  campaign  in  this  region,  which  led  to  the  sur- 
render  of  Burgoyne,  the  treachery  of  Arnold,  and  he  was 
an  eye-witness  of  the  tragic  end  of  poor  Major  Andr6. 
You  wiU  not  find  it  easy  to  get  a  complete  set  of  his  writmgs. 
There  are  many  smgle  volumes  for  which  you  will  be  on 
the  look  out.    Caldwell's  AvkHnography  is  a  storehouse  of 
facts  (and  fancies !)  relating  to  the  University  of  Pennsyl- 
vania, to  Rush  and  to  the  early  days  of  the  Transylvania 
University  and  the  Cincinnati  schools.    Pickled,  as  it  is, 
in  vmegar,  the  work  is  sure  to  survive. 

Have  carefully  rebound  James  Jackson's  memoir  of  his 
son  (1836),  and  put  it  in  the  way  of  the  young  men  among 
your  readers.    Few  biographies  will  do  them  more  good. 
For  the  curious  pick  up  the  literature  on  the  Chapman- 
Pattison  quarrel,  and  anything,  in  fact,  relating  to  that 
vivacious  and  pugnacious  Scot,  Granville  Sharpe  Pattison. 
There  are  a  few  fuU-blown  medical  biographies  of  special 
interest  to  us :  The  life  and  writings  of  that  remarkable 
phUosopher  and  physician.  Wells,  of  Charleston.    The 
Ufe  of  John  C.  Warren  (1860)  is  full  of  interest,  and  m  the 
Essays  of  David  Hossack  you  will  get  the  inner  history  of 
the  profesfton  in  New  York  during  the  early  years  of  the 

824 


MEDICAL  BIBLI0GR>:PHY 

last  century.  In  many  ways  Daniel  Trake  is  the  most 
unique  figure  in  the  history  of  American  medicine.  Get 
his  Life,  by  Mansfield,  and  his  Pioneer  Life  in  Kentucky. 
He  literally  made  Cincinnati,  having  "  booned  "  it  in  the 
early  days  in  his  celebrated  Picture  of  Cincinnati,  1815. 
He  founded  nearly  everything  that  is  old  and  good  in 
that  city.  His  monumental  work  on  The  Diseases  of  the 
Mississippi  VaUey  is  in  every  library ;  pick  out  from  the 
catalogues  every  scrap  of  his  wilbings. 

I  must  bring  these  "  splintery,"  rambling  remarks  tr  a 
close,  but  I  hope  that  I  may  have  stirred  in  you  an  interest 
in  some  of  the  wider  aspects  oi  American  medical  bioblio- 
graphy — I  mean  aspects  other  than  the  daily  demand  upon 
you  for  new  books,  new  editions  and  new  joumab. 

Keep  ever  in  view,  each  one  in  this  circle,  the  important 
fact  that  a  library  should  be  a  storehouse  of  everything 
relating  to  his  history  of  the  profession  of  the  locality. 
Refuse  nothing,  especially  if  it  is  old ;  letters,  manuscripts 
of  all  kinds,  pictures,  everjrthing  illustrating  the  growth 
as  well  as  the  past  condition,  should  be  preserved  and 
tabulated.  There  is  usually  in  each  community  a  man 
who  is  fond  of  work  of  this  sort.  Encourage  him  in 
every  possible  way.  Think  of  the  legacy  left  by  Dr. 
Toner,  of  Washington,  rich  in  materials  for  the  history 
of  the  profession  during  the  Revolutionary  War !  There 
should  be  a  local  pride  in  collecting  the  writings  and 
manuscripts  of  the  men  who  have  made  a  school  or  a 
city  famous.  It  is  astonishing  how  much  manuscript 
material  is  stowed  away  in  old  chests  and  desks.  Take, 
for  example,  the  recent  "  find  "  of  Dr.  Cordell  of  the  letters 
of  the  younger  Wieaenthal,  of  Baltimore,  describing  student 
life  in  London  about  the  middle  of  the  eighteenth  century. 

826 


Mi 


1 


•    1 


AMERICAN  MEDICAL  BIBLIOGRAPHY 

Think  of  the  precious  letters  of  that  noble  old  man,  Nathan 
Smith,  full  of  details  about  the  foundations  of  the  Dart- 
mouth and  the  Yale  Schools  of  Medicine !  Valuable  now 
(too  valuable  to  be  in  private  hands),  what  will  they  be 
100  or  200  years  hence ! 

What  ohould  attract  us  aU  is  a  study  of  the  growth 
of  the  American  mind  in  medicine  since  the  starting  of  the 
colonies.    As  m  a  mirror  this  story  is  reflected  in  the 
literature  of  which  you  are  the  guardians  and  collectors— 
in  letters,  in  manuscrpts,  in  pamphlets,  in  books,  and  in 
journals.    In  the  eight  generations  which  have  passed, 
the  men  who  have  striven  and  struggled— men  whose  lives 
are  best  described  in  the  words  of  St.  Paul,  in  joumeyings 
often,  in  perils  of  water,  in  perils  in  the  city,  m  perils  in 
the  wilderness,  in  perils  in  the  sea,  in  weariness  and  pain- 
fulness,  in  watchings  often,  in  hunger  and  thirst,  and  in 
fastings— these  men,  of  some  of  whom  I  have  told  you 
somewhat,  have  made  us  what  we  are.    With  the  irre- 
vocable past  into  which  they  have  gone  lies  our  future,  since 
our  condition  is  the  resultant  of  forces  which,  in  these 
generations,  have  moulded  the  profession  of  a  new  and 
mighty  empire.    From  the  vantage  ground  of  a  young 
century  we  can  trace  in  the  literature  how  three  gi^at 
streams   of   influence— English,    French    and   German- 
have  blended  into  the  broad  current  of  American  medicine 
on  which  we  are  afloat.     Adaptiveness,   lucidity  and 
thoroughness  may  be  said  to  be  the  characteristics  of 
these  AngUcan,  GaUic  and  Teutonic  influences,  and  it  is  no 
smaU  part  of  your  duty  to  see  that  these  influences,  the 
combination  of  which  gives  to  medicine  on  this  continent  its 
distinctively  eclectic  quality,  are  maintained  and  extended; 

32fi 


XVI 


THE  HOSPITAL  AS  A  COLLEGE 


l« 


327 


Hw  Hospital  is  thft  only  proper  College  in  trfaich  to  rear  a  tme 
disciple  of  Aesculapius. 

ABntraiBT. 

Tlie  most  essential  part  of  a  student's  instruction  is  obtained, 
aa  I  believe,  not  in  the  lecture  room,  but  at  the  bedside.  Nothing 
seen  there  is  lost ;  the  rhythms  of  disease  are  learned  by  frequent 
repetition ;  its  unforeseen  occurrences  stamp  themselves  indelibly 
on  the  memory.  Before  the  studoit  is  aware  of  what  he  has 
acquired  he  has  learned  the  aspects  and  causes  and  probable  issue 
of  the  diseases  he  has  seen  with  his  teacher,  and  the  proper  mode 
of  dealing  with  them,  so  far  as  his  master  knows. 

OuviB  WxNDXLL  Houiis,  Introductory  Lecture,  1867. 


*l 


XVI 
THE  HOSPITAL  AS  A  COLLEGE 


THE  last  quarter  of  the  last  century  saw  many  remark- 
able changes  and  reformations,  among  which  in 
far-reaching  general  importance  not  one  is  to  be  compared 
with  the  reform,  or  rather  revolution,  in  the  teaching  of 
the  science  and  art  of  medicine.  Whether  the  conscience 
of  the  professors  at  last  awoke,  and  felt  the  pricking  of 
remorse,  or  whether  the  change,  as  is  more  likely,  was  only 
part  of  that  larger  movement  toward  larger  events  in  the 
midst  of  which  we  are  to-day,  need  not  be  here  discussed. 
The  improvement  has  been  in  three  directions :  in  demand- 
ing of  the  student  a  better  general  education ;  in  lengthening 
the  period  of  professional  study ;  and  in  substituting 
laboratories  for  lecture  rooms — ^that  is  to  say,  in  the  replace- 
ment of  theoretical  by  practical  teaching.  The  problem 
before  us  as  teachers  may  be  very  briefly  stated :  to  give 
to  our  students  an  education  of  such  a  character  that 
they  can  become  sensible  practitioners— the  destiny  of 
seven-eighths  of  them.  Toward  this  end  are  all  our 
endowments,  our  multiplying  laboratories,  our  complicated 
curricula,  our  palatial  buildings.    In  the  four  years'  course 

*  Academy  of  Medicine,  New  York,  1903. 
829 


i; 


hi) 


ilA 


THE  HOSPITAL  AS  A  COLLEGE 
«  division  is  very  properly  made  between  the  preparatory 
or  scientific  branches  and  the  practical ;  the  former  are 
taught  in  the  school  or  college,  the  latter  in  the  hospital. 
Not  that  there  is  any  essential  difference ;  there  may  be  as 
much  science  taught  in  a  course  of  surgery  as  in  a  course  of 
embryology.    The  special  growth  of  the  medical  school  m 
the  past  25  years  has  been  in  the  direction  of  the  practical 
teaching  of  science.    Everywhere  the  lectures  have  been 
supplemented  or  replaced  by  pro     „  I  practical  courses, 
and  instead  of  a  single  laboratory  devoted  to  anatomy, 
there  are  now  laboratories  of  physiology,  of  physiological 
chemistry,  of  pathology,  of  pharmacology,  and  of  hygiene. 
Apart  from  the  more  attractive  mode  of  presentation  and 
the  more  useful  character  of  the  knowledge  obtained  m 
this  way,  the  student  learns  to  use  the  instruments  of 
precision,  gets  a  mental  training  of  incalculable  value,  and 
perhaps  catches  some  measure  of  the  scientific  spirit.    The 
main  point  is  that  he  has  no  longer  merely  theoretical 
knowledge  acquired  in  a  lecture  room,  but  a  first-hand 
practical  acquaintance  with  the  things  themselves.    He  not 
only  has  dissected  the  sympathetic  system,  but  he  has  set 
up  a  kymograph  and  can  take  a  blood  pressure  observation, 
he  has  personally  studied  the  action  of  digitalis,  of  chloro- 
form and  of  ether,  be  has  made  his  own  culture  media  and 
he  has  "  plated  "  organisms.    The  young  fellow  who  is 
Bent  on  to  us  in  his  third  year  is  nowadays  a  fairly  well- 
trained  man  and  in  a  position  to  begin  his  life's  work  in 
those  larger  laboratories,  private  and  public,  which  nature 
fills  with  her  mistakes  and  experiments. 

How  can  we  make  the  work  of  the  student  in  the  third 
and  fourth  year  as  practical  as  it  k  in  his  first  and  second  ? 

330 


i.-TniiiT-T.rT-iif 


THE  HOSPITAL  AS  A  COLLEGE 

I  take  it  for  granted  we  all  feel  that  it  should  be.    The 
answer  it,  take  him  from  the  lecture-room,  take  him  from 
the  amphitheatre— put  him  m  the  out-patient  department 
—put  him  m  the  wards.    It  is  not  the  systematic  lecture, 
not  the  amphitheatre  clinic,  not  even  the  ward  class— all 
of  which  have  their  value— in  which  the    reformation  is 
needed,  but  m  the  whole  relationship  of  the  senior  student  to 
the  hospital.    During  the  first  two  years,  he  is  thoroughly  at 
home  m  the  laboratories,  domiciled,  we  may  say,  with  his 
place  in  each  one,  to  which  he  can  go  and  work  quietly  under 
a  tutor's  direction  and  guidance.    To  parallel  this  condition 
in  the  third  and  fourth  years  certain  reforms  are  necessary. 
First,  in  the  conception  of  how  the  art  of  medicine  and 
surgery  can  be  taught.  My  firm  conviction  is  that  we  should 
start  the  third  year  student  at  once  en  his  road  of  life. 
Ask  any  physician  of  twenty  years'  standing  how  he  has 
become  proficient  in  his  art,  and  he  will  reply,  by  constant 
contact  with  disease ;  and  he  will  add  that  the  medicine  he 
learned  in  the  schools    was  totally  different  from  the 
medicine  he  learned  at  the  bedside.    The  graduate  of  a 
quarter  of  a  century  ago  went  out  with  little  practical 
knowledge,  which  increased  only  as  his  practice  increased. 
In  what  may  be  called  the  natural  method  of  teaching  the 
student  begins  with  the  patient,  contmues  with  the  patient, 
and  ends  hia  studies  with  the  patient,  using  books  and  lec- 
tures as  tools,  as  means  to  an  end.    The  student  starts,  in 
fact,  as  a  practitioner,  as  an  observer  of  disordered  machines, 
with  the  structure  and  orderly  functions  of  which  he  is 
perfectly  familiar.    Teach  him  how  to  observe,  give  him 
plenty  of  facts  to  observe,  and  the  lessons  will  come  out  of 
the  facts  themselves.    For  the  junior  student  in  medicine 

881 


ii 


THE  HOSPITAL  AS  A  CX>LLEaE 

and  luigerj  it  is  a  safe  role  to  have  no  teaching 
without  a  patient  (or  a  text,  and  the  best  teaching  is  that 
taught  by  the  patient  himself.  The  whole  art  of  medicine 
is  in  observation,  as  the  old  motto  goes,  but  to  educate  the 
eye  to  see,  the  ear  to  hear  and  the  finger  to  feel  takes  time, 
and  to  make  a  beginning,  to  start  a  man  on  the  right  path,  is 
all  that  we  can  do.  We  expect  too  much  of  the  student 
and  we  try  to  teach  him  too  much.  Give  him  good  methods 
and  a  proper  point  of  view,  and  all  other  things  will  be 
added,  as  his  experience  grows. 

The  second,  and  what  is  the  most  important '  >.  jzm,  is 
in  the  hospital  itself.  In  the  interests  of  tl  medical 
student,  of  the  profession,  and  of  the  public  at  large  we 
must  ask  from  the  hospital  authorities  much  greater  facili- 
ties than  are  at  present  enjojred,  at  least  by  the  students  of  a 
majority  of  the  medical  schools  of  this  country.  The  work  of 
the  third  and  fourth  year  should  be  taken  out  of  the  medical 
school  entire^^  and  transferred  to  the  hospital,  which,  as 
Abemethy  rtuarks,  is  the  proper  college  for  the  medical 
student,  in  his  last  years  at  least.  An  extraordinary 
difficulty  here  presents  itself.  While  there  are  institutions 
in  which  the  students  have  all  the  privileges  to  be  desired, 
there  are  others  in  which  they  are  admitted  by  side  entrances 
to  the  amphitheatre  of  the  hospital,  while  from  too  many  the 
students  are  barred  as  hurtful  to  the  best  interests  of  the 
patients.  The  work  of  an  institution  in  which  there  is  no 
teaching  is  rarely  first  class.  There  is  not  that  keen  interest, 
nor  the  thorough  study  of  the  cases,  nor  amid  the  exigencies 
of  the  busy  life  is  the  hospital  physician  able  to  escape 
clinical  slovenliness  unless  he  teaches  and  in  turn  is  taught 
by  assistants  and  students.    It  is,  I  think,  safe  to  say  that 

882 


THE  HOSPITAL  AS  A  COLLEGE 

in  »  hospital  with  students  in  the  wards  the  patients  are 
more  carefully  looked  after,  their  diseases  are  more  fully 
studied  and  fewer  mistakes  made.  The  larger  question,  of 
the  extended  usefulness  of  the  hospital  in  promoting  the 
diffusion  of  medical  and  surgical  knowledge,  I  cannot  here 
consider. 

I  envy  for  our  medical  students  the  advantages  enjoyed 
by  the  nurses,  who  live  in  daily  contact  with  the  sick,  and 
who  have,  in  this  country  at  least,  supplanted  the  former 
in  the  affections  of  the  hospital  trustees. 

The  objection  often  raised  that  patients  do  not  like  to 
have  students  in  the  wards  is  entirely  fanciful.  In  my 
experience  it  is  just  the  reverse.  On  this  point  I  can  claim 
to  speak  with  some  authority,  having  served  as  a  hospital 
physician  for  more  than  26  years,  and  having  taught 
chiefly  m  the  wards.  With  the  exercise  of  ordinary  dis- 
cretion, and  if  one  is  actuated  by  kindly  feelings  towards 
the  patients,  there  is  rarely  any  difficulty.  In  the  present 
state  of  medicine  it  is  very  difficult  to  carry  on  the  work 
of  a  first-rlass  hospital  without  the  help  of  students.  We 
ask  far  too  much  of  the  resident  physicians,  whose  number 
has  not  increased  in  proportion  to  the  enormous  increase 
in  the  amount  of  work  thrust  upon  them,  and  much  of  the 
routine  work  can  be  perfectly  well  done  by  senior  students. 

II 
How,  practically,  can  this  be  carried  into  effect  ?  Let 
us  take  the  third  year  students  first.  A  class  of  100  students 
maybe  divided  into  ten  sections,  each  of  which  maybe  called 
a  clinical  unit,  which  should  be  in  charge  of  one  instructor. 
Let  us  follow  the  course  of  such  a  unit  through  the  day. 

sas 


i 


r 


t 


u 


I  :i 


TBI':   H08i'.^Ti»L  AS  A  COLLEGE 

On  Mondays,  ^Vedne^Kyj,  and  Fridays  at  0  a.m.  element- 
ary instruction  in  phyt»i(.al  diagnosis.  From  10  to  12  a.m. 
practical  instruction  in  the  out-patient  department.  This 
may  consist  hi  part  in  seeing  the  cases  in  a  routine  way,  in 
receiving  instruction  how  to  take  histories,  and  in  becoming 
familiar  with  the  ordinary  aspect  of  disease  as  seen  in  a 
medical  outcl  inic .  At  12  o'clock  a  senior  teacher  could  meet 
four,  or  even  five,  of  the  units,  dealing  more  systematically 
with  special  cases.  The  entire  morning,  or,  where  it  is 
customary  to  have  the  hospital  practice  in  the  afternoon,  a 
large  part  of  the  afternoon,  two  or  three  hours  at  least, 
should  be  spent  in  the  out-patient  department.  No  short  six 
weeks*  course,  but  each  clinical  unit  throughout  the  sessi)  ^n 
should  as  a  routine  see  out-patient  practice  under  skilled 
direction.  Very  soon  these  students  are  able  to  take 
histories,  have  learned  how  to  examine  the  cases,  and  the 
out-patient  records  gradually  become  of  some  value.  Of 
course  all  of  this  means  abundance  of  clinical  material, 
proper  space  in  the  out-patient  department  for  teaching, 
sufficient  apparatus  and  young  men  who  are  able  and  willing 
to  undertake  the  work. 

On  the  alternate  days,  Tuesdays,  Thursdays  and  Satur 
days,  the  clinical  unit  (which  we  are  following)   is  m  t\ 
surgical    out-patient   department,    seeing   minor  surger} 
learning  how  to  bandage,  to  give,  ether,  and  helping  in  ad 
the  interesting  w(  rk  of  a  surgical  dispensary     Groups  of 
three  or  four  units  should  be  in  charge  of  a  'emoiistrator  of 
morbid  anatomy,  who  would  take    hem  to  post  nortems, 
the  individual  men  doing  the  work,  and  one  day  li  *^hc  w(  ek 
Ml  the  units  could  sHend  the  morisiH  anatorr     ^'pnmn. 


stration  of  the  professor  of  pathology. 

334 


I  take  it  foe  t^ranted 


1 


THE  HOSPIIAL  A8  A   COLLEGE 

that  the  4udent  has  go  »o  lar  :hat  he  haa  fiiushed  hi* 
pathological  hiatology  in  s  sec  1  year  vhich  is  the  case 
in  the  more  advanced  schools. 

Other  hours  of  the  day  or  the  third  y  ar  could  be  de- 
voted to  the  teaching  of  obstetrics,  materi*  medica,  thera- 
peutics, hygiene  and  clinical  microscopy.  At  the  end  of 
the  session  in  a  well-conducted  school  the  third-year 
student  is  rcallv  a  very  well-informed  fellow.  He  knows 
tht  difference  between  Pott's  disease  and  Pott's  fn  ire ; 
he  can  readily  feel  an  enlarged  spleen,  t  id  hf'  know  le 
difference  between  Charcot's  crystals  and  Char  ot's  joint 

In  the  fourth  year  1  would  .nil  maintain  the  mni'^al  un^ 
of  ten  men,  whose  wr  k  would  be  transferred  frc      aeot 
patient  department  to  the  wards.    Fach  ma    ihoul '  bt^ 
allowed  to  serve  in  the  medical,  and,  for  a  k         period  af^ 
possible,  in  the  sunrical  wards.    He  .«?*  oul     be  assigned 
four  or  five  .  .eds.    He  has  bad  experi  n.    enough  in  his 
third  year  r  ^  enable  liim  to  take      e  hi.'*tory  of  the  new 
cases,  whu  ;i  would  need,  of  course  sup'^Tvi  ..m  )r  correction 
by  the  senior  house  officer  or  atte    iirig  physic^n      Under 
the  siipervioion  of  the  house  physician  '     '1oe«  all  of  the 
work '   iijected  with  '  la  own  patients     n    v  «  A  the  urine, 
etc.,  and  take?  the  da  y  rerord  as  dk  v  the  attending 

physics  in.  One  >r  two  of  t' ■>  dim  *.  utti  are  taken 
round  the  wards  three  or  four  times  m  tl  week  by  one 
of  the  teachers  for  a  couple  of  hours,  the  cases  commented 
upon,  the  students  asked  questions  and  the  groups  made 
familiar  'nth  tKo  progress  of  tli.  ca«es.  In  this  way  the 
student  gets  a  tamiliarity  with  diaeasie,  a  practical  know- 
ledge  of  clinic,  method,  and  a  practical  knowledge  of  how 
to  treat  disease.    With  equal  advantage  the  same  plan 

835 


I"'  fi 


K 


{     : 


\s\^ 


u 


I 


I 
I 


■^ 


THE  HOSPITAL  AS  A  COLLEGE 

can  be  followed  in  the  suxgicsl  wards  and  in  the  obstetrical 
and  gynecological  departments. 

An  old  method,  it  is  the  only  method  by  which  medicine 
and  surgery  can  be  taught  properly,  as  it  is  the  identical 
manner  in  which  the  physician  is  himself  taught  when  he 
gets  into  practice.  The  radical  refor-:  needed  is  in  the 
introduction  into  this  country  of  the  system  of  clinical 
clerks  and  surgical  dressers,  who  should  be  just  as  much  a 
part  of  the  machinery  of  the  wards  as  the  nurses  or  the 
house  physicians. 

There  is  no  scarcity  of  material;  on  the  contrary,  thero 
is  abundance.  Thmk  of  the  plethora  of  patients  in  this 
city,  the  large  majority  of  whom  are  never  seen,  not  to  say 
touched,  by  a  medical  student !  Think  of  the  hundreds  of 
typhoid  fever  patients,  the  daily  course  of  whose  disease  is 
never  watched  or  studied  by  our  pupils !  Think  how  few 
of  the  hundreds  of  cases  of  pneumonia  which  will  enter 
the  hospitals  during  the  next  three  months,  will  be  seen 
daily,  hourly,  in  the  wards  by  the  fourth  year  men  !  And 
yet  it  is  for  this  they  are  in  the  medical  school,  just  as  much 
as,  more  indeed,  than  they  are  in  it  to  learn  the  physiology 
of  the  liver  or  the  anatomy  of  the  hip- joint. 

But,  you  may  ask,  how  does  such  a  plan  work  m  prac- 
tice ?  From  a  long  experience  I  can  answer,  admirably  ! 
It  has  been  adopted  in  the  Johns  Hopkins  Medical  School, 
of  which  the  hospital,  by  the  terms  of  the  founder's  will,  is 
an  essential  part.  There  is  nothing  special  in  our  material, 
our  wards  are  not  any  better  than  those  in  other  first-class 
hospitals,  but  a  distinctive  feature  is  that  greater  provision 
is  made  for  teaching  students  and  perhaps  for  the  study 
of  disease.    Let  me  tell  you  in  a  few  words  just  how  the 

836 


( 


THE  HOSPITAIi  AS  A  (    i  ^EGE 
work  is  conducted.    The  third  year  students  are  taught 

medicine : 

First,  in  a  systematic  course  of  physical  diagnosis  con- 
ducted by  Drs.  Thayer  and  Futcher,  the  Associate  Professors 
of  Medicine,  in  the  rooms  adjacent  to  the  out-patient 
department  In  the  second  half  of  the  year,  after  receiving 
instruction  in  history-taking,  the  students  take  notes  and 
examine  out-patients. 

Seooruay,  three  days  in  the  week  at  the  conclusion  of 
the  out-patient  hours,  the  entire  class  meets  the  teacher  in 
an  adjacent  room,  and  the  students  are  taught  how  to 
examine  and  study  patients.  It  is  remarkable  how  many 
interesting  cases  can  be  shown  in  the  course  of  a  year  in  this 
way.  Each  ctudent  who  takes  a  case  is  expected  to  report 
upon  and  "  keep  track  "  of  it,  and  is  questioned  with  refer- 
ence to  its  progress.  The  opportunity  is  taken  to  teach  the 
student  how  to  look  up  questions  in  the  literature  by  setting 
subjects  upon  which  to  report  in  connexion  with  the  case-j 
they  have  seen.  A  class  of  fifty  can  be  dealt  with  very 
conveniently  in  this  manner. 

Thirdly,  the  clinical  microscopy  class.  The  clinical 
laboratory  is  part  of  the  hospital  equipment.  It  is  in  charge 
of  a  senior  assistant,  who  is  one  of  the  resident  officers  of 
the  hospital.  There  is  room  in  it  for  about  one  hundred 
students  on  two  floors,  each  man  having  his  own  work-table 
and  locker  and  a  place  in  which  he  can  have  his  own  speci- 
mensandworkat  odd  hours.  The  course  is  a  systematic  one, 
giventhroughout  the  session,  from  two  hours  to  twohours  and 
a  half  twice  a  week,  and  consists  of  routine  instruction  in  the 
methods  of  examining  the  blood  and  secretions,  the  gastric 
contents,  urine,  etc.  This  can  be  made  a  most  invaluable 
AR  837  z 


il   : 
■  *:   ■ 


THE  HOSPITAL  AS  A  CX)LLEGE 

course,  enabling  the  student  to  continue  the  microscopic 
work  which  he  has  had  in  his  first  and  second  years,  and  he 
{amiliarizes  himself  with  the  use  of  a  valuable  instrument, 
which  becomes  in  this  way  a  clinical  tool  and  not  a  mere  toy. 
The  clinical  laboratory  in  the  medical  school,  should  be 
connected  with  the  hospital,  of  which  it  is  an  essential  part. 
Nowadays  the  microscopical,  bacteriological  and  chemical 
work  of  the  wards  demands  skilled  labour,  and  the  house 
physicians  as  well  as  the  students  need  the  help  and  super- 
vision o'  experts  in  clinical  chemistry  and  bacteriology, 
who  shoxJd  form  part  of  the  resident  staff  of  the  institution. 

Fourthly,  the  general  medical  clinic.  One  day  m  the 
week,  in  the  amphitheatre,  a  clinic  is  held  for  the  third 
and  fourth  year  students  and  the  more  interesting  cases  in 
the  wards  are  brought  before  them.  As  far  as  possible  we 
present  the  diseases  of  the  reasons,  and  in  the  autumn 
special  attention  is  given  to  malarial  and  typhoid  fever, 
and  later  in  the  winter  to  pnevimonia.  Committees  are 
appointed  to  report  on  every  case  of  pneumonia  and  the 
complications  of  typhoid  fever.  There  are  no  systematic 
lectures,  but  in  the  physical  diagnosis  classes  there  are  set 
recitations,  and  in  what  I  call  the  observation  class  in  the 
dispensary  held  three  times  a  week,  general  statements  are 
often  made  concerning  the  diseases  imder  consideration. 

Fourth  Year  Ward  Work. — The  class  is  divided  into  three 
groups  (one  in  rr  .odicine,  one  insurgery,  a  .d  one  in  obstetrics 
and  gysenology)  which  serve  as  clinical  clerks  and  surgical 
dressers.  In  medicine  each  student  has  five  or  six  beds.  He 
takes  notes  of  the  new  cases  as  they  come  in,  does  the  urine 
and  blood  work  and  helps  the  house  physician  in  the  general 
care  of  the  patients.    From  nine  to  eleven  the  visit  is  made 

338 


%. 


i 


THE   HOSPITAL  AS  A  COLLEGE 
with  the  clinical  clerks,  and  systematic  instruction  is  given. 
The  interesting  cases  are  seen  and  new  cases  are  studied, 
and  the  students  questioned  with  reference  to  the  symptoms 
and  nature  of  the  disease  and  the  course  of  treatment. 
What  I  wish  to  emphasize  is  that  this  method  of  teaching  is 
not  a  ward-ckss  in  which  a  group  of  students  is  taken  mto 
the  ward  and  a  case  or  two  demonstrated  ;  it  is  ward-work, 
the  students  themselves  taking  their  share  in  the  work  of 
the  hospital,  just  as  much  as  the  attending  physician,  the 
interne,  or  the  nurse.    Moreover,  it  is  not  an  occasional 
thing.    His  work  in  medicine  for  the  three  months  is  his 
major  subject  and  the  clinical  clerks  have  from  nine  to 
twelve  for  their  ward-work,  and  an  hour  in  the  afternoon  in 
which  some  special  questions  are  dealt  with  by  the  senior 
assistant  or  by  the  house  physicians. 

The  Recitation  Class.—ks  there  are  no  regular  lectures, 
to  be  certain  that  all  of  the  subjects  in  medicine  are  brought 
before  the  students  in  a  systematic  manner,  a  recitation 
class  is  held  once  a  week  upon  subjects  set  beforehand. 

The  WeeUy  Clinic  in  the  amphitheatre,  in  which  the 
clinical  clerks  take  Xea^tng  parts,  as  they  report   upon 
their  cases  and  read  the  notes  of  their  cases  brought  before 
th?  class  for  consideration.    Certain  important  aspects  of 
medicine  are  constantly  kept  before  this  class.    Week  after 
week  the  condition  of  the  typhoid  fever  cases  is  discussed, 
the   more  interesting  cases    shown,    the    complications 
systematically  placed  upon  the  board.  A  pneumonU  com- 
mittee deals  with  all  the  clinical  features  of  this  common 
disease,  and  a  list  of  the  cases  is  kept  on  the  blackboard, 
»nd  during  a  session  the  students  have  reports  upon  fifty 
or  sixty  cases,  a  large  majority  of  which  are  seen  in  the 

889 


•"I 
li 


f 


, 


THE  HOSPITAL  AS  A  COLLEGE 

clinic  by  all  of  them,  while  the  clinical  clerks  have  in  the 
wards  an  opportunity  of  studying  them  daily. 

The  general  impression  amung  the  students  and  the  junior 
teachers  is  that  the  system  has  worked  well.  There  are 
faults,  perhaps  more  than  we  see,  but  I  am  sure  they  are 
not  in  the  system.  Many  of  the  students  are  doubtless 
not  well  informed  theoretically  on  some  subjects,  as 
personally  I  have  always  been  opposed  to  that  base  and 
moi^t  pernicious  system  of  educating  them  with  a  view  to 
examinations,  but  even  the  dullest  learn  how  to  examine 
patients,  and  get  familiar  with  the  changing  aspects  of  the 
important  acute  diseases.  The  pupil  handles  a  sufficient 
number  of  cases  to  get  a  certain  measure  of  technical  skill, 
and  there  is  ever  kept  before  him  the  idea  that  he  is  not  in 
the  hospital  to  learn  everything  that  is  known  but  to  learn 
how  to  study  disease  and  how  to  treat  it,  or  rather,  how  to 
treat  patients. 

Ill 
A  third  change  is  in  reorganization  of  the  medical  school. 
This  has  been  accomplished  in  the  first  two  years  by  an 
extraordinary  increase  in  the  laboratory  work,  which  has 
necessitated  an  increase  in  the  teaching  force,  and  indeed  an 
entirely  new  conception  of  how  such  subjects  as  physiology, 
pharmacology  and  pathology  should  be  taught.  A  corres- 
ponding reformation  is  needed  in  the  third  and  fourth 
years.  Control  of  ample  clinical  facilities  is  as  essential 
to-day  as  large,  well-endowed  laboratories,  and  the  absence 
of  this  causes  the  clinical  to  lag  behind  the  scientific  edu- 
cation. Speaking  for  the  Department  of  Medicine,  I  should 
say  that  three  or  four  well-equipped  medical  clinics  of  fifty 

840 


THE  HOSPITAL  AS  A  CiOLLEQE 

to  seventy-five  beds  each,  with  out-patient  departments 
under  the  control  of  the  directors,  are  required  for  a  school  of 
maximum  size,  say  800  students.    Within  the  next  quarter 
of  a  century  the  larger  universities  of  this  country  will 
have  their  own  hospitals  in  which  the  problems  of  nature 
known  as  disease  will  be  studied  as  thoroughly  as  are  those 
of  geology  or  Sarscrit.    But  even  with  present  conditions 
much  may  be  done.    There  are  hundreds  of  earnest  students, 
thousands  of  patients,  and  scores  of  weU-equipped  young 
men  willing  and  anxious  to  do  practical  teaching.    Too 
often,  as  you  know  full  well,  "  the  hungry  sheep  look  up 
and  are  not  fed ; "    for  the  bread  of  the  wards  they  are 
given  the  stones  of  the  lecture-room  and  amphitheatre.    The 
dissociation  of  student  and  patient  is  a  legacy  of  the  per- 
nicious system  of  theoretical  teaching  from  which  we  have 
escaped  in  the  first  and  second  years. 

For  the  third  and  fourth  year  students,  the  hospital 
b  the  coUege ;  for  the  juniors,  the   out-patient  depart- 
ment and  the  clinics ;  for  the  seniors,  the  wards.    They 
should  be  in  the  hospital  as  part  of  its  equipment,  as  an 
essential  part,  without  which  the  work  cannot  be  of  the  best. 
They  should  be  in  it  as  the  place  in  which  alone  they  can 
learn  the  elements  of  tho''  art  and  the  lessons  which  will 
be  of  service  to  them  when  in  practice  for  themselves. 
The  hospital  with  students  in  its  dispensaries  and  wards 
doubles  its  usefulness  m  a  community.    The  stimulus  of 
their  presence  neutralizes  that  clinical  apathy  certain, 
sooner  or  later,  to  beset  the  man  who  makes  lonely  "  rounds  " 
with  his  house-physician.    Better  work  is  done  for  the  pro- 
fession and  for  the  public  ;  the  practical  education  of  young 
men,  who  carry  with  them  to  all  parts  of  the  country  good 

841 


THE  HOSPITAL  AS   A  COLLEGE 


^. 


methods,  extends  enormously  the  work  of  an  institution, 
and  the  profession  is  recruited  by  men  who  have  been 
tau(^t  to  think  and  to  observe  for  themselves,  and  who 
become  independent  practitioners  of  the  new  school  of 
scientific  medicine — ^men  whose  faith  in  the  possibilities 
of  their  art  has  been  strengthened,  not  weakened,  by  a 
knoviiedge  of  its  limitations.  It  is  no  new  method  which  I 
advocate,  but  the  old  method  of  Boerhaave,  of  the  elder 
Rutherford  of  the  Edinburgh  school,  of  the  older  men  of 
this  city,  and  of  Boston  and  of  Philadelphia — the  men 
who  had  been  pupils  of  John  Hunter  and  of  Rutherford 
and  of  Saunders.  It  makes  of  the  hospital  a  college  in 
which,  as  clinical  clerks  and  surgical  dressers,  the  students 
slowly  learn  for  themselves,  under  skilled  direction,  the 
phenomena  of  disease.  It  is  the  true  method,  because  it  is 
the  natural  one,  the  only  one  by  which  a  physician  grows 
in  clinical  wisdom  after  he  begins  practice  for  himself — all 
others  are  bastard  substitutes. 


Ill 


H    = 

?%-l:^^i^ 


848 


xvn 

ON     THE     EDUCATIONAL     VALUE 
OF  THE  MEDICAL  SOCIETY. 


848 


u 


i( 


'A 


! 

I.    '<   ; 


Let  tu  hold  faat  the  profeaaion  of  our  faith  without  wavering.  .  .  . 
and  let  us  consider  one  another,  to  provolce  unto  love  and  to  good 
works :  not  forsaking  the  assembling  of  ourselves  together,  as  the 
D&anner  of  some  is. 

Efistlx  to  thi  Hibbxws,  Chapter  z. 

The  want  of  energy  is  one  of  the  main  reasons  why  so  few  persons 
continue  to  improve  in  later  years.  They  have  noc  the  will,  and 
do  not  know  the  way.  They  "  never  try  an  experiment "  or  look 
up  a  point  of  interest  for  themselves ;  they  make  no  sacrifices  for 
the  saJce  of  knowledge ;  their  minds,  like  their  bodies,  at  a  certain 
age  become  fixed.  Genius  has  br>n  defined  as  "the  power  of 
taking  pains  "  ;  but  hardly  any  one  keeps  up  his  interest  in  know- 
ledge throughout  a  whole  life.  The  troubles  of  a  familv,  the 
business  of  making  money,  the  demands  of  a  profession  i  troy 
the  elasticity  of  the  mind.  The  waxen  tablet  of  the  m<  -nory, 
which  was  ;  vice  capable  of  receiving  "true  thoughts  and  olear 
impreesionB,"  becomes  hard  and  crowded ;  there  is  no  room  for 
the  accumulations  of  a  long  life  {Thecet,  194  if.).  The  student, 
as  years  advance,  rather  makes  an  exchange  of  knowledge  than 
adds  to  his  stores. 

Jowett's  Introductions  to  Plato. 


844 


XVII 

ON     THE     EDUCATIONAL     VALUE 
OF  THE  MEDICAL  SOCIETY' 


A 


S  the  Autocrat  remarks : 


Little  of  all  we  value  here 

Wake*  on  the  mom  of  its  hundredth  year. 


All  the  more  reason  to  honour  such  occasions  as  the 
present  in  an  appropriate  manner.    The  tribute  of  words 
that  I  gladly  bring— and  that  you  may  take  as  expressing 
the  sentiments  of  your  brethren  at  large— necessarily 
begins  with  congratulations  that  your  society  has  passed 
into  the  select  group  of  those  that  have  reached  a  century 
of  existence.    But  congratulations  must  be  mingled  with 
praise  of  the  band  of  noble  men  who,  in  1803,  made  this 
gathering  possible.    It  is  true  they  did  but  follow  the  lead 
of  their  colleagues  of  Litchfield  County  and  their  own 
example  when,  in  1784,  the  physicians  of  this  county 
organized  what  is  now  one  of  the  oldest  medical  societies 
in  the  land.    In  the  introduction  to  the  volume  of  Transac- 
tiona  of  this  Society,  published  m  1788,  the  following  brief 
statements  are  made  as  to  the  objects  of  the  organization, 

i  Centennial  celebration  of  the  New  Haven  Medical  Association 
New  Haven.  January  6.  10OS. 

845 


i{-. 


<■ 


ON  THE  EDUCATIONAL  VALUE 

which  may  be  tniuposed  from  the  parent  to  the  child, 
and  which  I  quote  in  Ulustration  of  the  character  of  the 
men  and  as  giving  in  brief  the  chief  uses  of  a  medical 
society :  "  This  society  was  formed  on  the  most  liberal 
and  generous  principles,  and  was  designed,  first,  to  lay  a 
foundation  for  that  unanimity  and  friendship  which  u 
essential  to  the  dignity  and  usefulness  of  the  profession ; 
to  accomplish  which,  they  resolved,  secondly,  to  meet 
once  in  three  months ;  thirdly,  that  in  all  cases  where  counsel 
is  requisite  they  will  assist  each  other  without  reserve; 
fourthly,  that  all  reputable  practitioners  in  the  country, 
who  have  been  in  the  practice  for  one  year  or  more,  may 
be  admitted  members ;  fifthly,  that  they  will  communicate 
their  observations  on  the  air,  seasons  and  climate,  with 
such  discoveries  as  they  may  make  m  physic,  surgery, 
botany  or  chemistry,  and  deliver  faithful  histories  of  the 
various  diseases  incident  to  the  inhabitants  of  this  country, 
with  the  mode  of  treatment  and  event  in  singular  cases ; 
sixthly,  to  open  a  correspondence  with  the  medical  societies 
in  the  neighbouring  states  and  in  Europe,  for  which  purpose 
they  have  a  standing  committee  of  correspondence ; 
seventhly,  to  appoint  a  committee  for  the  purpose  of 
examining  candidates  for  the  profession,  and  to  give 
certificates  to  the  deserving."  Changed  conditions  have 
changed  some  of  these  objects,  but  m  the  main  they  hold 
good  to-day. 

Some  of  the  paragraphs  have  suggested  to  me  the  subject 
of  my  address — the  educational  value  of  the  medical 
society.  There  are  many  problems  and  difficulties  in  the 
education  of  a  medical  student,  but  they  are  not  more 
difficult  than  the  question  of  the  continuous  education  of 

846 


T^» 


OF  THE  MEDICAL  SOCIETY 
the  general  practvtiowr.    Over  the  one  we  have  some 
control,  over  the  other,  none.    The  university  and  the 
state  board  m»'  e  it  certain  that  the  one  has  a  mmunum, 
at  least,  of  proi  J«ional  knowledge,  but  who  can  be  cerUin 
of  the  state  of  that  knowledge  of  the  other  in  five  or  ten 
years  from  the  date  of  his  graduation  ?    The  specialist 
may  be  trusted  to  take  care  of  himself-the  conditions 
of  his  existence  demand  that  he  shaU  be  abreast  of  the 
times ;   but  the  family  doctor,  the  private  m  our  peat 
army,  the  essential  factor  in  the  battle,  should  be  carefully 
nurtured  by  the  schools  and  carefully  guarded  by  the 
public.    Humanly  speaking,  with  him  are  the  issues  of 
life  and  death,  since  upon  him  falls  the  grevious  responsi- 
bUity  in  those  terrible  emergencies  which  bring  darkness 
and  despair  to  so  many  households.    No  ckss  of  men 
needs  to  call  to  mind  more  often  the  wise  comment  of 
Plato  that  education  is  a  life-long  business.    The  difficulties 
are  partly  adherent  to  the  subject,  partly  have  to  do  with 
the  individual  and  his  weakness.    The  problems  of  disease 
are  more  complicated  and  difficult  than  any  others  with 
which  the  trained  mind  has  to  grapple ;    the  conditions 
in  any  given  case  may  be  unlike  those  in  any  other ;  each 
case,  indeed,  may  have  its  own  problem.    Law,  constantly 
looking  back,  has  its  forms  and  procedures,  its  precedents 
and  practices.    Once  grasped,  the  certainties  of  divinity 
make  its  study  a  delight  and  its  practice  a  pastmie ;  but 
who  can  tell  of  the  uncertainties  of  medicine  as  an  art  1 
The  science  on  which  it  is  based  b  accurate  and  definite 
enough ;  the  physics  of  a  man's  circulation  are  the  physics 
of  the  waterworks  of  the  town  in  which  he  Uves.  but  once 
out  of  gear,  you  cannot  apply  the  same  rules  for  the  repair 

347 


\n 


ON  THE  EDUCATIONAL  VAI.UE 


T 


^ 


{ 


of  the  one  M  of  the  other.  Vftmbility  ie  the  Uw  of  life, 
•nd  M  no  two  faces  are  the  same,  so  no  two  bodies  are  alike, 
and  no  two  individuals  react  alike  and  behave  alike  under 
the  abnormal  conditions  which  we  know  as  disease.  This  is 
the  fundamental  di£Bculty  in  the  education  of  the  physician, 
and  one  which  he  may  never  grasp,  or  he  takes  it  so  tenderly 
that  it  hurts  instead  of  boldly  accepting  the  axiom  of 
Bishop  Butler,  more  true  of  medicine  than  of  any  other 
profession :  "  Probability  is  the  guide  of  life."  Surrounded 
by  people  who  demand  certainty,  and  not  philosopher 
enough  to  agree  with  Locke  that  **  FrchiAUity  $upjilies 
the  defect  of  our  knowledge  and  gwden  u»  when  that  faUa 
and  ia  always  canvertant  about  things  of  which  toe  have  no 
certainty,"  the  practitioner  too  often  gets  into  a  habit  of 
mind  which  resents  the  thought  that  opinion,  not  full 
knowledge,  must  be  his  stay  and  prop.  There  is  no  dis- 
credit, though  there  is  at  times  much  discomfort,  in  this 
everlasting  perhaps  with  which  we  have  to  preface  so  much 
connected  with  the  practice  of  our  art.  It  is,  as  I  said, 
inherent  in  the  subject.  Take  in  illustration  an  experience 
of  last  week.  I  saw  a  patient  with  Dr.  Bolgiano  who 
presented  marked  pulsation  to  the  left  of  the  sternum  in 
the  second,  third  and  fourth  interspaces,  visible  even  before 
the  night-dress  was  removed,  a  palpable  impulse  over  the 
area  of  pulsation,  flatness  on  percussion,  accentuated 
heart  sounds  and  a  soft  systolic  bruit.  When  to  this  were 
added  paralysb  of  the  left  recurrent  laryngeal  nerve, 
smallness  of  the  radial  pulse  on  the  left  side,  and  tracheal 
tugging,  there  is  not  one  of  you  who  would  not  make, 
under  such  circumstances,  the  diagnosis  of  aneurism  of  the 
aorta.    Few  of  us,  indeed,  would  p'lt  in  the  perhaps,  or 

848 


'!.  m 


OF  THE  MEDICAL  SOCIETY 
think  o!  it  M  ft  probftbility  with  such  a  combination  of 
phywcftl  •igns,  and  yet  the  ;v^sociate  contutions  wiiich  had 
been  present-a  smaU  priiuu  tun. our  of  the  left  lobe  of 
the  thyroid,  with  secondary  iiodul^  in  ih  iytnpU  g'.ands 
of  the  neck  and  involvement  of  tho  raediasrinum  and 
metastases  in  the  brain  with  optic  neurtifl-leit  no  question 
that  the  tumour  causing  the  remarkable  intrathoracic  com- 
bination was  not  aneurismal  but  malignant.  Listen  to  the 
appropriatecommentof  the  Fatherof  Medicine, who  twenty- 
five  centuries  ago  had  not  only  grasped  the  fundamental 
conception  of  our  art  as  one  based  on  observation,  but  had 
laboured  aUo  through  a  long  life  to  give  to  the  profession 
which  he  loved  the  saving  health  of  science— listen,  I  say, 
to  the  words  of  his  famous  aphorism :  "  Exj>erience  is 
faUacunu  and  judgmerU  difficult ! " 

But  the  more  serious  problem  relates  to  the  education  of 
the  practitioner  after  he  has  left  the  schools.  The  founda- 
tion may  not  have  been  laid  upon  which  to  erect  an  intel- 
lectual structure,  and  too  often  the  man  starts  with  a  total 
misconception  of  the  prolonged  struggle  necessary  to  keep 
the  educatiuu  he  has,  to  say  nothing  of  bettering  the 
instruction  of  the  schools.  As  the  practice  of  medicine 
is  not  a  business  and  can  never  be  one,'  the  education  of 

»  In  every  age  there  have  \yt^n  EUjaha  ready  to  give  up  in  deepair 
at  the  progresa  of  comiu.  cialism  in  the  profeeaion.  Garth  says 
in  1699  (Diaptntary)—  .      ,.    j 

How  aickening  Physick  hangs  her  pensive  head 
And  what  was  once  a  Science,  now's  a  Trade. 
Of  medicine,  many  are  of  the  opinion  expressed  by  one  of  Aken- 
side's  disputants  at  Tom's  Coffee  House,  that  the  <^aciente  en- 
deavoured  to  nLke  it  a  science  and  faUed,  and  the  moderns  to 
make  it  a  trade  and  have  succeeded.  To-day  the  cry  »  louder 
than  ever,  and  in  truth  there  are  groundn  for  alarm ;  but,  on  the 

849 


i 


n 


■  ' 

• 

«  t 

*-r 

1 

■«-i 

A 

t; 

1 

•t 

ON  THE  EDUCATIONAL  VALUE 

the  heart— the  moral  side  of  the  man— must  keep  pace  with 
the  education  of  the  head.  Our  fellow  creatures  cannot 
be  dealt  with  as  man  deals  in  com  and  coal ;  "  the  human 
heart  by  which  we  live"  must  control  our  professional 
relations.  Aftcjr  all,  the  personal  equation  has  most  to 
do  with  success  or  failure  in  medicine,  and  in  the  trials 
of  life  the  fire  which  strengthens  and  tempers  the  metal 
of  one  may  soften  and  ruin  another.  In  his  philosophy 
of  life  the  young  doctor  will  find  Rabbi  Ben  Ezra '  a  better 
guide,  with  his  stimulating 

Then,  welcome  each  rebuff 

That  turns  earth's  smoothness  rough, 

Each  sting  that  bids  nor  sit  nor  stand  but  go  I 

than  Omar,  whose  fatalism,  so  seductive  in  Fitzgerald's 
verses,  leaves  little  scope  for  human  effort. 

For  better  or  worse,  there  are  few  occupations  of  a  more 
satisfying  character  than  the  practice  of  medicine,  if  a 
man  can  but  once  get  orientirt  and  bring  to  it  the  philosophy 
of  honest  work,  the  philosophy  which  insists  that  we 
are  here,  not  to  get  all  we  can  out  of  the  life  about  us, 
but  to  see  how  much  we  can  add  to  it.  The  discontent 
and  grumblings  which  one  hears  have  their  source  in  the 
man  more  often  than  in  his  environment.  In  the  nature 
of  the  material  in  which  we  labour  and  of   which,  by 


other  han<^.  we  can  say  to  these  Elijahs  that  there  are  many  more 
than  7,000  left  who  have  not  bowed  the  knee  to  this  Baal,  but  who 
practise  caiUe  ctute  tt  probe. 

»  See  Browning's  poem.  A  good  Uttle  edition  has  just  been 
issued  (with  an  introduction  by  William  Adams  Slade),  which  I 
oommead  tc  young  graduates. 

850 


.'lU, 


OF  THE   MEDICAL  SOCIETY 

the  way,  we  are  partakers,  there  ia  much  that  could 
be   improved,  but,  as  Mrs.  Poyser   remarks,  we  must 
accept  men  as  the  Lord  made  them,  and  not  expect  too 
mudi.    But  let  me  say  this  of  the  public :   it  is  rarely 
responsible  for  the  failures  in  the  profession.    Occasionally 
a  man  of  superlative  merit  is  neglected,  but  it  is  because 
he  lacks  that  most  essential  gift,  the  knowledge  how  to  use 
his  gifts.  The  failure  in  99  per  cent,  of  the  cases  is  m  the  man 
hinielf ;  he  has  not  started  right,  the  poor  chap  has  not 
had  the  choice  of  his  parents,  or  his  education  has  been 
faulty,  or  he  has  fallen  away  to  the  worship  of  strange  gods, 
Baal  or  Ashtoreth,  or  worse  still,  Bacchus.    But  after  all 
the  kilUng  vice  of  the  young  doctor  is  intellectual  laziness. 
He  may  have  worked  hard  at  college,  but  the  years  of 
probation  have  been  his  rum.    Without  specific  subjects 
upon  which  to  work,  he  gets  the  newspaper  or  the  novel 
habit,  and  fritters  his  energies  upon  useless  literature. 
There  is  no  greater  test  of  a  man's  strength  than  to  make 
him  mark  time  in  the  "  stand  and  wait "  years.    Habits 
of  systematic  reading  are  rare,  and  are  becoming  more 
rare,  and  five  or  ten  years  from  his  license,  as  practice 
begins  to  grow,  may  find  the  young  doctor  knowing  less 
than  he  did  when  he  started  and  without  fixed  educational 
purpose  in  life. 

Now  here  is  where  the  medical  society  may  step  in  and 
prove  his  salvation.  The  doctor's  post-graduate  education 
comes  from  patients,  from  books  and  journals,  and  from 
societies,  which  should  be  supplemented  every  five  or 
six  years  by  a  return  to  a  post-graduate  school  to  get  rid 
of  an  almoft  inevitable  slovenliness  in  methods  of  work. 
0!  his  chief  teachers,  his  patients,  I  cannot  here  speak. 

861 


i'i 


ON  THE  EDUCATIONAL  VALUE 

Each  case  has  ito  lesson-a  lesson  that  may  be,  but  is  not 
always,  learnt,  for  clinical  wisdom  U  not  the  eqmvalent 
of  experience.  A  man  who  has  seen  600  cases  oi  pneumoma 
may  not  have  the  understanding  of  the  disease  which  comes 
with  an  intelligent  study  of  a  score  of  cases,  so  different 
are  knowledge  and  wisdom,  which,  as  the  poet  truly  sa^, 
"  far  from  being  one  have  ofttimes  no  connexion."  Nor 
can  I  speak  of  his  books  and  journals,  but  on  such  an  occa- 
sion  as  the  present  it  seems  appropriate  to  say  a  few  words 
on  the  educational  value  of  the  medical  society. 

The  first,  and  in  some  respects  the  most  miportant, 
function  is  that  mentioned  by  the  wise  founders  of  your 
parent  society-to  Uy  a  foundation  for  that  um^  and 
friendship  which  is  essential  to  the  dignity  and  usefutoess 
of  the  profession.    Unity  and  friendship !    How  we  aU 
long  for  them,  but  how  difficult  to  attain !    Strife  seems 
rather  to  be  the  verv  Ufe  of  the  practitioner,  whose  warfare 
is  incessant  against  disease  and  agamst  ignorance  and 
prejudice,  and.  sad  to  have  to  admit,  he  too  often  lets  his 
angry  passions  rise  against  his  professional  brother.    The 
quarrels  o!  doctors  make  a  pretty  chapter  in  the  history 
of  medicine.    Each  generation  seems  to  have  had  its  own. 
The  Coans  and  the  Cnidians.  the  Arabians  and  the  Galenists. 
the  humoraUsts  and  the  soUdists.  the  Brunonians  and  the 
Broussaisians.  the  homcepaths  and  the  regulars,  have   m 
different  centuries,  rent  the  robe  of  .Esculapius.   But  these 
larger  quarrels  are  becoming  less  and  less  intense,  and  m 
the  last  century  no  new  one  of  moment  sprang  up,  whUe 
it  is  easy  to  predict  that  in  the  present  century,  when 
science  has  fully  leavened  the  dough  of  homoepathy,  the 
areat  breach  oi  our  day  wiU  be  healed.    But  in  too  many 
*  862 


:i\ 


OF   THE   MEDICAL  SOCIETY 

towns  and  smaller  communities  miserable  factions  prevails, 
and  bickerings  and  jealousies  mar  the  dignity  and  useful- 
ness of  the  profession.    So  far  as  my  observation  goes, 
the  fault  lies  with  the  older  men.    The  young  fellow,  if 
handled  aright  and  made  to  feel  that  he  is  welcomed  and 
not  regarded  as  an  intruder  to  be  shunned,  is  only  too 
ready  to  hold  out  the  hand  of  fellowship.    The  societj 
comes  in  here  as  professional  cement.    The  meetings  in  a 
friendly  social  way  lead  to  a  free  and  open  discussion  of 
differences  in  a  spirit  that  refuses  to  recognize  differences 
of  opinion  on  the  non-essentials  of  life  as  a  cause  of  per- 
sonal animosity  or  ill-feeling.    An  attitude  of  mind  habi- 
tually friendly,  more  particularly  to  the  young  man,  even 
though  you  feel  him  to  be  the  David  to  whom  your  king- 
dom may  fall,  a  little  of  the  old-fashioned  courtesy  which 
makes  a  man  shrink  from  wounding  the  feelings  of  a 
brother  practitioner— m  honour  preferring  one  another ; 
with  such  a  spirit  abroad  in  the  society  and  among  its 
older  men,  there  is  no  room  for  envy,  hatred,  malice  or 
any  uncharitableness.    It  is  the  confounded  tales  of  patients 
that  so  often  set  us  by  the  ears,  but  if  a  man  makes  it  a 
rule  never  under  any  circumstances  to  believe  a  story  told 
by  a  patient  to  the  detriment  of  a  fellow-practitioner 
—even  if  he  knows  it  to  be  true  !— though  the  measure  he 
metes  may  not  be  measured  to  him  again,  he  will  have  the 
satisfaction  of  knowing  ihat  he  has  clo.-ed  the  ears  of  his 
soul  to  ninety-nine  lies,  and  to  have  misse  i  the  hundredth 
truth  will  not  hurt  him.    Most  of  the  quarrels  of  doctors 
are  about  non-essential,  miserable  trifles  and  annoyances 
—the  pin  pricks  of  practice — which  would  sometimes  try 
the  patience  of  Job,  but  the  good-fellowship  and  friendly 


% 


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( 


ON  THE  EDUCATIONAL  VALUE 
intercourse  of  the  medical  society  should  reduce  these  to  a 

minimum. 

The  well-conducted  medical  society  should  represent  a 
clearing  house,  in  which  every  physician  of  the  district 
would  receive  his  inteUectual  rating,  and  in  which  he  could 
find  out  his  professional  assets  and  liabilities.    We  doctors 
do  not  "  take  stock  "  often  enough,  and  are  very  apt  to 
carry  on  our  shelves  stale,  out-of-date  goods.    The  society 
helps  to  keep  a  man  "  up  to  the  times,"  and  enables  him 
to  refurnish  his  mental  shop  with  the  latest  wares.    Rightly 
used,  it  may  be  a  touchstone  to  which  he  can  bring  his 
experiences  to  the  test  and  save  him  from  falling  into  the 
rut  of  a  few  sequences.    It  keeps  his  mind  open  and  recep- 
tive, and  counteracts  that  tendency  to  premature  senility 
which  is  apt  to  overtake  a  man  who  lives  in  a  routine. 
Upon  one  or  two  speciaUy  valuable  features  of  the  society 
I  may  dwell  for  a  moment  or  two. 

In  a  city  association  the  demonstration  of  instructive 
specimens  in  morbid  anatomy  should  form  a  special  feature 
of  the  work.    After  aU  has  been  done,  many  cases  of  great 
obscurity  in  our  daily  rounds  remain  obscure,  and  as  post- 
mortems are  few  and  far  between,  the  pnvate  practitioner 
is  at  a  great  disadvantage,  since  his  mistakes  in  diagnosis 
are  less  often  corrected  than  are  those  of  hospital  physicians. 
No  more  instructive  work  U  possible  than  carefully  demon- 
strated specimens  illustrating  disturbance  of  function  and 
explanatory  of  the  clinical  symptoms.    It  is  hard  in  this 
country  to  have  the  student  see  enough  morbid  anatomy, 
the  aspects  of  which  have  such  an  important  bearing  upon 
the  mental  attitude  of  the  growing  doctor.    For  the  crass 
therapeutic  credulity,  so  widespread  to-day,  and  upon  which 

364 


1 


OF  THE  MEDICAL  SOCIETY 

our  manttfactaring  chemists  wax  fat,  there  is  no  more 
potent  antidote  than  the  healthy  scepticism  bred  of  long 
study  in  the  post-mortem  room.    The  new  pathology,  so 
fascinating  and  so  time-absorbing,  tends,  I  fear,  to  grow 
away  from  the  old  morbid  anatomy,  a  training  in  which 
is  of  such  incalculable  advantage  to  the  physician.    It  is  a 
subject  which  one  must  learn  in  the  medical  school,  but 
the  time  assigned  is  rarely  suflScient  to  give  the  student 
a  proper  grasp  of  the  subject.    The  younger  men  should  be 
encouraged  to  make  the  exhibition  of  specimens  part  of  the 
routine  work  of  each  meeting.    Something  may  be  learned 
from  the  most  ordinary  case  if  it  is  presented  with  the 
special  object  of  illustrating  the  relation  of  disturbed 
function  to  altered  structure.    Of  still  greater  educational 
value  is  the  clinical  side  of  the  society.    No  meeting  should 
be  arranged  without  the  presentation  of  patients,  par- 
ticularly those  illustrating  rare  and  unusual   forms  of 
disease.    Many  diseases  of  the  skin  and  of  the  joints,  a 
host  of  nervous  affections,  and  many  of  the  more  remark- 
able of  general  maladies,  as  myxcedema,  cretinism,  achon- 
droplasia, etc.,  are  seen  so  rarely  and  yet  are  so  distinctive, 
requiring  only  to  be  seen  to  be  recognized,  that  it  is  in- 
cumbent upon  members  to  use  the  society  to  show  such 
cases.    A  clinical  evening  devoted  to  these  rarer  affections 
is  of  very  great  help  in  diffusing  valuable  knowledge. 
The  importance  of  a  clinical  demonstration  was  never  better 
illustrated  than  at  the  International  Congress  in  London 
in  1881,  when  Dr.  OrA  and  others  presented  one  morning 
at  the  Clinical  Museum  a  group  of  cases  of  myxcedema. 
There  were  men  from  all  parts  of  the  world,  and  the 
general  recognition  of  the  disease  outside  of  England  datca 

856 


J 


If 


I 


I 


if 

'A 


•      I 


ON  THE  EDUCATIONAL  VALUE 
from  that  meeting.    The  phyBiognomy  of  disease  is  learned 
slowly,  and  yet  there  are  a  great  many  affections  which  can 
be  recognized,  sometimes  at  a  glance,  more  often  by  careful 
inspection,  without  any  history.    The  society  should  be  a 
school  in  which  the  scholars  teach  each  other,  and  there 
is  no  better  way  than  by  the  demonstration  of  the  more 
unusual  cases  that  happen  to  fall  in  your  way.    I  have 
gone  over  my  history  cards  of  private  patients  brought  or 
sent  to  me  by  last-year  physicians,  in  which  the  disease 
was  not  diagnosed  though  recognizable  de  mm.    Gout, 
pseudo-hypertrophic  muscular  paralysis,  hysterical  lordosis, 
spondylitis  deformans,  preataxic  tabes  (myosis,  ptosis, 
etc).    Graves'    disease.    Parkinson's    disease,    anorexia 
nerv'osa.  Raynaud's  disease,  pernicious  ansemia,  spastic 
diplegia,  spastic  hemiplegia  and  cyanosis  of  chrome  empny- 
sema  were  on  the  list.    Some  of  these  are  rare  diseases, 
but  at  an  active  society  in  the  course  of  a  few  years  every 
one  of  them  could  be  demonstrated. 

The  presentation  of  the  histories  of  cases  may  be  made 
very  instructive,  but  this  is  often  a  cause  of  much  weariness 
and  dissatisfaction.    A  brief  oral  statement  of  the  special 
features  of  a  case  is  much  to  be  preferred  to  a  long,  written 
account.    The  protocol  or  daily  record  of  a  long  case  shouW 
never  be  given  in  full.    The  salient  points  should  be  brought 
out  particularly  the  relation  the  case  bears  to  the  known 
features  of  the  disease  and  to  diagnosis  and  treatment. 
The  volume  of  the  Transactions  of  the  New  Haven  County 
Medical  Society,  1788.  contains  many  admirably  reported 
cases     I  select  one  for  special  comment,  as  it  is,  so  far 
as  1  know,  the  first  case  on  record  of  a  most  remarkable 
disease  to  which  much  attention  has  been  paid  of  late— 

866 


OF  THE  MEDICAL  SOCTETY 
the  hypertrophic  stenosis  of  the  pylorus  in  chUdren  (see 
fuU  discussion  in  the  Lancet  ol  December  20,  1902).    Dr; 
Hezekiah  Beardsley  reports  a  Cote  of  Schirrhus  of  the 
Pylonu  of  an  Infant.   Every  feature  of  the  disease  as  we 
know  it  now  is  noted— the  constant  puking,  the  leanness, 
the  wizened,  old  look  of  the  child  are  weU  described,  and 
the  diagnosis  was  made  four  months  before  death !    The 
post-mortem  showed  a  dilated  and  hypertrophied  stomach 
and  "the  pylorus  was  invested  with  a  hard,  compact 
substance  or  schirrosity  which  so  completely  obstructed 
the  passage  into  the  duodenum,  as  to  admit  with  the  greatest 
difficulty  the  finest  fluid."    If  other  men  had  been  as 
accurate  and  careful  as  Dr.  Beardsley,  and  if  other  societies 
had  foUowed  the  good  example  set  so  early  by  the  New 
Haven  County  Medical  Association,  not  only  would  this 
rare  disease  have  been  recognized,  but  by  the  accumulation 
of  accurate  observations  many  another  disease  would  have 
yielded  its  secret.    But  it  illustrates  the  old  story— there 
is  no  more  difficult  art  to  acquire  than  the  art  of  observation, 
and  for  some  men  it  is  quite  as  difficult  to  record  an 
observation  in  brief  and  plain  language. 

In  no  way  can  a  society  better  help  in  the  education  of 
its  members  than  in  maintaining  for  them  a  good  library, 
and  I  am  glad  to  know  that  this  is  one  of  your  functions. 
It  is  most  gratifying  to  note  the  growing  interest  in  this 
work  in  all  parts  of  the  country.     In  the  last  number  of 
the  Bulletin  of  the  Association  of  Medical  Librarians  there 
is  a  list  of  twenty-five  societies  with   medical  libraries. 
An  attractive  reading-room,  with  the   important  weekly 
journals,  and  with  shelves  stocked  with  the  new  books  in 
different   departments,    becomes    an   educational    centre 

857 


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ii 


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t. 


f 


i 
r 


ON  THE  EDUCATIONAL  VALUE 
in  which  the  young  man  can  keep  up  his  training  and  to 
which  the  older  practitioner  can  go  for  advice  when  he  is 
in  despair  and  for  reassurance  when  he  is  in  doubt.  The 
self-sacrifice  necessary  to  establish  and  maintain  such  a 
Ubrary  does  good  to  the  men  who  take  part  in  it ;  harmony 
is  promoted,  and,  in  the  words  of  your  fathers,  the  dignity 
and  usefulness  of  the  profession  are  maintained. 

Why  is  it  that     'arge  majority  of  all  practitioners  are 
not  members  of  a  medical  society  1    Dr.  Simmons  estimates 
that  there  are  77,000  physicians  in  the  United  States  who 
do  not  belong  to  any  medical  aociety  whatever !    In  part 
this  is  due  to  apathy  of  the  officers  and  faUure  to  present 
an  attractive  programme,  but  more  often  the  fault  is  in  the 
men.    Perhaps  given  over  wholly  to  commercialiam  a 
doctor  feels  it  a  waste  of  time  to  job  a  society,  and  ao  it 
is  if  he  is  in  the  profession  only  for  the  money  he  can  get 
out  of  patients  without  regard  to  the  sacred  obligation 
to  put  himself  In  the  best  possible  position  to  do  the  best 
that  is  known  for  them.    More  frequently,  1  fear,  the 
"  doUar-doctor "  is  a  regular  frequenter  of  the  society, 
knowing  full  well  how  suicidal  in  the  long  run  is  isolation 
from  tho  general  body  of  the  profession.    The  man  who 
knows  it  all  and  gets  nothing  from  the  society  reminds 
one  of  that  little  dried-up  miniature  of  humanity,  the  pre- 
macurely  senile  infant,  whose  tabetic  marasmus  has  added 
old  age  to  infancy.    Why  should  he  go  to  the  society  and 
hear  Dr.  Jones  on  the  gastric  relations  of  neurasthenia 
when  he  can  get  it  all  so  much  better  in  the  works  of 
Einhorn  or  Ewald  ?    He  is  weary  of  seeing  appendices, 
and  there  are  no  new  pelvic  viscera  for  demonstration. 
It  is  a  waste  of  time,  he  says,  and  he  feels  better  at  hcv-ie, 

058 


OF  THE  MEDICAL  SOCIETY 
and  perh»p«  that  is  the  beat  place  for  a  man  who  has 
reached  this  stage  of  intellectual  stagnation. 

Greater  sympathy  must  be  felt  for  the  man  who  has 
started  aU  right  and  has  worked  hard  at  the  societies, 
but  as  the  rolling  years  have  brought  ever-mcreasing 
demands  on  his  time,  the  evening  hours  fiiid  hmi  worn 
out  yet  not  able  to  rest,  much  less  to  snatch  a  little  diver- 
sion  or  instruction  in  the  company  of  his  feUovi-s  whom  he 
loves  so  weU.    Of  all  men.  in  the  profession  *.he  forty- 
visit-a-day  man  is  the  most  to  be  pitied.    Not  always  an 
automaton,  he  may  sometimes  by  economy  of  words  and 
ertraordinarv  energy  do  his  work  well,  but  too  often  he 
is  the  one  above  all  others  who  needs  the  refreshment  of 
mind  and  recreation  that  is  to  be  had  in  a  well-conducted 
society     Too  often  he  is  lost  beyond  aU  recall,  o^d,  Uke 
Ephraim  joined  to  his  idoU,  we  may  leave  him  alone^ 
Many  good  men  are  ruined  by  success  in  practice,  and  need 
to  pray  the  prayer  of  the  Litany  against  the  evib  of 
prosperity.    It  is  only  too  true,  as  you  know  well,  that  a 
most  successful-as  the  term  goes-doctor  may  practise 
with  a  clinical  slovenliness  that  makes  it  impossible  for 
that  kind  old  friend,  Dame  Nature,  to  cover  his  mistakes. 
A  well-conducted  society  may  be  of  the  greatest  help  in 
stimulating  the  practitioner  to  keep  up  habits  of  scientific 
study.    It  seems  a  shocking  thing  to  say,  but  you  all  know 
it  to  be  a  fact  that  many,  very  many  men  in  large  practice 
never  use  a  stethoscope,  and  as  for  a  microscope,  they  have 
long  forgotten  what  a  leucocyte  or  a  tube  cast  looks  like. 
This  in  some  cases  may  be  fortunate,  as  imperfect  or  half 
knowledge  might  only  lead  to  mistakes,  but  the  secret  of 
this  neglect  of  means  of  incalculable  holp  is  the  fact  that 

869 


ON  THE  EDUCATIONAL  VALUE 
he  hM  not  atUined  the  full  and  enduring  knowledge  which 
should  h»ve  been  given  to  him  in  the  medical  school. 
It  is  astonishing  with  how  little  outside  aid  a  large  practice 
may  be  conducted,  but  it  is  not  astonishing  that  in  it 
cruel  and  unpardonable  mistakes  are  made.  At  whose 
door  so  often  Ues  the  responsibility  for  death  in  cases  of 
empyema  but  at  that  of  the  busy  doctor,  who  has  not  time 
to  make  routine  examinations,  or  who  is  "  so  driven  "  that 
the  urine  of  his  scarlet  fever  or  puerperal  patients  is  not 
examined  until  the  storm  has  broken  ? 

But  I  hear  it  sometimes  said  you  cannot  expect  the  general 
practitioner,  particularly  in  country  districts,  to  use  the 
microscope   and   stethoscope— these   are   refinements   of 
diagnosis.    They  are  not !    They  are  the  essential  means 
which  can  be  used  and  should  be  used  by  every  intelligent 
practitioner.    In   our   miserable,   antiquated   system   ot 
teaching  we  send  our  graduates  out  wholly  unprepared 
to  make  a  rational  diagnosis,  but  a  man  who  is  in  earnest 
—and,  thank  heaven!    most  of  the  young  men  to-day 
in  the  profession  are  in  earnest— can  supply  the  defects 
in  his  education  by  careful  study  of  his  cases,  and  can 
supplement  the  deficiency  by   a  post-gra-liiate  course. 
A  room  fitted  as  a  small  laboratory,  \^  aii   .he  necessary 
chemicals  and  a  microscope,  will  prove  a  better  investment 
in  the  long  run  than  a  static  machine  or  a  new-fangled 
air-pressure  spray  apparatus. 

It  is  not  in  the  local  society  only  th.\t  a  man  can  get 
encouragement  in  his  day's  work  and  a  betterment  of 
mind  and  methods.  Every  practitioner  should  feel  a 
pride  in  belonging  to  his  stete  society,  and  should  attend 
the  meetings  whenever  possible,  and  gradually  learn  to 

360 


OF  THE  BiEDICAL  SOCIETY 
know  biB  coUe«gue«.  and  here  let  me  direct  your  attention 
to  an  important  movement  on  the  pMt  of  the  Amencan 
Medical  Association,  which  has  for  its  object  the  organua- 
tion  of  the  profession  throughout  the  entire  country. 
This  can  be  accomplished  only  by  a  uniformity  in  the 
organization  of  the  state  societies,  and  by  making  the 
county  society  the  unit  through  which  members  are  ad- 
mitted to  the  state  and  natiomd  bodies.    Those  of  you 
interested  will  find  very  instructive  information  on  this 
subject  in  the  Jwmd  of  the  association  in  a  series  of  papers 
by  Dr.  Simmons,  the  editor,  which  have  been  repnnted 
in  pamphlet  form.    As  now  managed,  with  active  sections 
conducted  by  good  men  from  all  parts  of  the  country,  the 
meeting  of  the  National  Association  is  in  itself  a  sort  of 
brief  post-graduate  course.    Those  of  you  at  the  receptive 
age  who  attended  the  Saratoga  meeting  last  June  must  have 
been  impressed  with  the  educational  value  of  such  a 
gathering.    The  Annual  Museum  was  itself  an  important 
education  in  certain  lines,  and  the  papers  and  discussions 
in  the  various  sections  were  of  the  greatest  possible  value. 
But  I  need  say  no  more  to  this  audience  on  the  subject 
of  medical  societies ;  you  of  New  England  have  not  "  for- 
saken the  gath-ring  of  yourselves  together  as  the  manner 
ot  some  is,"  but  have  been  an  example  to  the  whole  country. 
In  the  dedication  of  his  Hdy  War,  fhomas  Fuller  has 
some  very  happy  and  characteristic  remarks  on  the  bounden 
duty  of  a  man  to  better  his  heritage  of  birth  or  fortune, 
and  what  the  father  found  glass  and  made  crystal,  he  urges 
the  son  to  find  crystal  and  make  peari.    Your  heritage 
has  been  most  exceptional,  and.  I  believe,  from  all  that 
I  know  of  the  profession  in  this  city  and  State,  that  could 

961 


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MICROCOPY  RESOLUTION  TEST  CHART 

NATIONAL  BUREAU  OF  STANDARDS 

STANDARD  REFERENCE  MATERIAL  1010a 

(ANSI  and  ISO  TEST  CHART  No.  2) 


EDUCATIONAL  VALUE   OF  MEDICAL    SOCIETY 
your  fathers  return  they  would  say  that  of  their  crystal 
you  had  made  pearl.    One  cannot  read  their  history  as  told 
by  Bronson,  or  as  sketched  by  your  distinguished  citizen, 
my  colleague,  Dr.  Welch,  without  a  glow  of  admiration 
for  their  lofty  ideals,  their  steadfastness  and  devotion, 
and  for  their  faith  in  the  profession  which  they  loved- 
The  times  have  changed,  scondition  of  practice  have  altered 
and  are  altering  rapidly,  but  when  such  a  celebration  takes 
us  back  to  your  origin  in  simpler  days  and  ways,  we  find 
that  the  ideals  which  inspired  them  are  ours  to-day- 
ideals  which  are  ever  old,  yet  always  fresh  and  new,  and 
we  can  truly  say  in  Kipling's  words : 

The  men  bulk  big  on  the  old  trail,  our  own  trail,  the  out  trail. 
They're  God's  own  guides  on  the  Long  Trail,  the  trail  that  is 
always  new. 


862 


XVIIl 


THE  MASTER-WORD  IN  MEDICINE 


363 


If  any  oi.e  is  desiroua  of  carrying  cut  in  detail  the  Platonic 
education  of  after-life,  some  such  counsols  as  the  foUowing  may 
be  offered  to  him :  That  he  shaU  chooee  the  branch  of  knowledge 
to  which  hia  own  mind  moBt  distinctly  inclines,  and  in  which  he 
takes  the  greatest  deUght,  either  one  which  seems  to  connect  with 
hip  own  daily  employment,  or,  perhaps,  furnishes  the  greatest 
contrast  to  it.    He  may  study  from  the  speculative  side  the  pro- 
fession or  business  in  which  he  is  practically  engaged.    He  may 
make  Homer,  Dante,  Shakespeare<  Plato,  Bacon  the   friends  and 
companions  of  his  Ufe.     He  may  find  opportunities  of  hearing 
the  living  voice  of  a  great  teacher.     He  may  select  for  mquiry 
some  point  of  history,  or  some  unexplained  phenomenon  of  nature. 
An  hour  a  day  passed  in  such  scientific  or  Uterary  pursmta  will 
furnish  as  many  facts  as  the  memory  can  retain,  and  will  give  him 
"a  pleasure  not  to  be  repented  of"  (Timaus,  59   D).     Only  let 
him  beware  of  being  the  slave  of  crotchets,  or  of  running  after  a 
Will  o'  the  Wisp  in  his  ignorance,  or  in  1  is  vanity  of  attnbutii.g 
to  himself  the  gifts  of  a  poet,  or  assuming  the  air  of  a  philosopher. 
He  should  know  the  limits  of  his  own  powers.    Better  to  build  up 
the  mind  by  slow  additions,  to  creep  on  quietly  from  one  thmg 
to  another,  to  gain  insensibly  new  powers  and  new  mterests  in 
knowledge,  than  to  form  vast  schemes  which  are  never  destined 

to  be  realized.  .       .    „,  . 

JoWKTT,  Introductions  to  Flato. 

Contend,  my  soul,  for  moments  and  for  hours ; 
Each  is  with  service  pregnant,  each  reclaimed 
Is  Uke  a  Kingdom  conquered,  where  to  reign. 

Robert  Louis  Stevenson. 

In  the  case  of  our  habits  we  are  only  masters  of  the  beginning, 
their  growth  by  gradual  stages  being  imperceptible,  like  the  growth 

of  disease.  ,  _^, . 

Abistotle,  Ethics. 


864 


XVIII 
THE  MASTER-WORD  IN   MEDICINE 

I 

BEFORE  proceeding  to  the  plewmg  duty  of  addressing 
the  „ndergraduat»».  as  a  native  of  this  P^vmce  and 
as  an  old  student  ol  this  sehool.  I  must  say  a  few  words  on 
he  momentous  changes  inaugurated  with  th«  «  he 
r^t  important,  perhaps,  which  have  token  pl«:e  n  the 
Ltory  of  the  profession  in  OnUrio.    The  splendid  labora- 
rihich  we  saw  opened  this  afternoon,  a  witness  to  the 
^^reciation  by  the  authorities  of  the  needs  of  science  m 
icme,  makes  possible  the  highest  standards  of  edu^a 
tion  in  the  subjects  upon  which  our  Art  -  has  j.    They 
may  do  more.    A  Uberal  policy,  with  a  due  regard  to  the 
truth  that  the  greatness  of  a  school  Ue,  m  l"f^-  "  ""^^ 
should  build  up  a  great  scientiic  centre  which  wdl  brmg 
r^  L  to  thU  city  and  to  our  country     The  men  in  charge 
of  the  departments  are  of  the  right  stamp.    See  to  it  that 
;;« treat'them  ^n  the  right  way  by  givmg  skiUed  assi  ,.a„ce 
Lough  to  ensure  that  the  vitality  of  men  who  could  work 
Z  tt  world  is  not  »pped  ty  the  routine  of  t^achmg.^' 
"gret  wiU,  I  know,  be  m  the  mmds  of  nany  of  my  younger 
Xrs.    The  removal  of  the  department  of  anatomy  and 
1  University  of  Toronto,  1903. 
365 


% 


mA    . 


THE   MASTER-WORD   IN   MEDICINE 

physiology  from  the  biological  laboratory  of  the  university 
breaks  a  connexion  which  has  had  an  important  influence 
on  medicine  in  this  city.  To  Professor  Ramsay  Wright  is 
due  much  of  the  inspiration  which  has  made  possible  these 
fine  new  laboratories.  For  years  he  has  encouraged  iii 
every  way  the  cultivation  of  the  scientific  branches  of  medi- 
cine and  has  unselfishly  devoted  much  time  to  projioting 
the  best  interests  of  the  Medical  Faculty.  And  in  passing 
let  me  pay  a  tribute  to  the  ability  and  zeal  with  which  Dr. 
A.  B.  Macallum  has  won  for  himself  a  world-wide  reputation 
by  mtricate  studies  which  have  carried  the  name  of  this 
University  to  every  nook  and  corner  of  the  globe  where  the 
science  of  physiology  is  cultivated.  How  much  you  owe 
to  him  in  connexion  with  the  new  buildings  I  need  scarcely 
mention  in  this  audience. 

But  the  other  event  which  we  celebrate  is  of  much  greater 
importance.  When  the  money  is  forthcoming  it  is  an  easy 
matter  to  join  stone  to  stone  in  a  stately  edifice,  but  it  is 
hard  to  find  the  market  in  which  to  buy  the  precious  cement 
which  can  unite  into  an  harmonious  body  the  professors  of 
medicine  of  two  rivpl  medical  schools  in  the  same  city.  That 
this  has  been  accomplished  so  satisfactorily  is  a  tribute  to 
the  good  sense  of  the  leaders  of  the  two  faculties,  and  tells 
of  their  recognition  of  the  needs  of  the  profession  in  the  pro- 
vince. Is  it  too  much  to  look  forward  to  the  absorption  or 
afl&liation  of  the  Kingston  and  London  schools  into  the 
Provincial  University  1  The  day  has  passed  in  which  the 
small  school  without  full  endowment  can  live  a  life  bene- 
ficial to  the  students,  to  the  profession  or  to  the  public.  I 
know  well  of  the  sacrifice  of  time  and  money  which  is  freely 
made  by  the  teachers  of  those  schools ;  and  they  will  not 

866 


THE  MASTER-WORD  IN  MEDICINE 
misunderstand  my  motives  when  I  urge  them  to  commit 
suicide,  at  least  so  far  as  to  change  their  organizations  mto 
clinical  schools  in  affiliation  with  the  central  university,  a* 
part,  perhaps,  of  a  widespread  affiliation  of  the  hospitals  of 
the  province.  A  school  of  the  first  rank  in  the  world,  such 
as  this  must  become,  should  have  ample  clinical  faculties 
under  its  own  control.  It  U  as  much  a  necessity  that  ae 
professors  of  medicine  and  surgery,  etc.,  should  ha  ,J 

hospital  services  under  their  control  throughout  the  year, 
as  it  is  that  professors  of  pathology  auc'  physiology  should 
have  laboratories  such  as  those  in  which  we  here  meet.    It 
should  be  an  easy  matter  to  arrange  between  the  provmcial 
authorities  and  the  vrustee.  of  the  Toronto  General  Hospita 
to  replace  the  present  antiquated  system  of  multiple  small 
services  by  modern  well-equipped  dlnics-three  in  medicmo 
and  three  in  surgery  to  begin  with.    The  increased  effi- 
ciency of  the  service  would  be  a  substantial  quid  pro  qw>,  but 
there  would  have  to  be  a  self-de.nying  ordinance  on  the  part 
of  many  of  the  attending  physicia-  -    With  the  large  num- 
ber of  students  in  the  combined  school  no  one  hospital  can 
furnish  in  practical  medicine,  surgery  and  the  specialties  a 
training  in  the  art  an  equivalent  of  that  which  the  student 
will  have  in  the  science  in  the  new  laboratories.    An  affilia- 
tion should  be  sought  with  every  other  hospital  in  the  city 
and  province  of  fifty  beds  and  over,  in  each  of  which  two 
or  three  extra-mural  teachers  could  be  recognized,  who 
would  receive  for  three  or  more  months  a  number  of  stu- 
dents proportionate  to  the  beds  in  the  hospital.    I  need 
not  mention  names.    We  all  know  men  in  Ottawa,  Ki'g- 
gton,  London,  Hamilton,  Cuelph  and  Chatham,  who  could 
take  charge  of  small  groups  of  the  senior  students  and  make 

867 


i 


THE   MASTER-WORD   IN   MEDICINE 

of  them  good  practical  doctors.  I  merely  throw  out  the 
suggestion.  There  are  difficulties  m  the  way  ;  but  is  there 
anything  worth  struggling  for  in  this  life  which  does  not 
bristle  with  them  ? 

Students  of  Medicine  :  May  this  day  to  be  each  of  youj 
as  it  was  to  me  when  I  entered  this  school  thirty-five  years 
ago,  the  beginning  of  a  happy  life  in  a  happy  calling.    Not 
one  of  you  has  come  here  with  such  a  feeling  of  relief  as  that 
which  I  experienced  at  an  escape  from  conic  sections  and 
logarithms  and  from  Hooker  and  Pearson.    The  dry  bones 
became  clothed  with  interest,  and  I  felt  that  I  had  at  last 
got  to  work.    Of  the  greater  advantages  with  which  you 
start  I  shall  not  speak.    Why  waste  my  words  on  what  you 
cannot  understand.    To  those  of  us  only  who  taught  and 
studied  m  the  dingy  old  building  which  stood  near  here  is 
it  given   to  feel  the  full  change  which    the  years  have 
wrought,  a  change  which  my  old  teachers,  whom  I  see  here 
to-day— Dr.  Richardson,  Dr.  Ogden,  Dr.  Thorburn  and  Dr. 
Oldright— must  find  hard  to  realize.    One  looks  about  in 
vain  for  some  accustomed  object  on  which  to  rest  the  eye 
m  its  backward  glance— all,  all  are  gone,  the  old  familiar 
places.    Even  the  landscape  has  altered,  and  the  sense  of 
loneliness  and  regret,  the  sort  of  homesickness  one  experi- 
ences on  such  occasions,  is  relieved  by  a  feeling  of  thankful- 
ness that  at  least  some  of  the  old  familiar  faces  have  been 
spared  to  see  this  day.    To  me  at  least  the  memory  of  those 
happy  days  is  a  perpetual  benediction,  and  I  look  back  upon 
the  two  years  I  spent  at  thi    school  with  the  greatest  de- 
light.   There  were  many  chux^s  that  might  have  been  im- 
proved—and we  can  say  the  same  of  every  medical  school 
of  that  period— but  I  seem  to  have  got  much  more  out  of  it 

368 


.\. 


THE  MASTER-WOBD  IN  MEDICINE 

,k„«,  picture  o.  the  period  .eem.  ^7  <U.wn^  Bu  .fter 
.n  «  »meone  h»  Kmarked,  in.tn.ot.on  »  often  the  U-t 
™^rt  of  an  education,  .nd,  .a  I  rec.ll  tkem  our  te«he,.  m 
Mr  life  .nd  doctrine  .et  forth  .  true  .nd  hvely  worf  to  th. 
JTt  enlightenment  of  our  d.rkne».    They  .tand  out  » 
fhe  b«lJo«nd  of  my  memory  »  a  group  of  men^«ho«  .n 
auence  and  example  were  mo.t  helphd.    In  W'"  .tn  B^ 
Beaumont  and  Edward  Mulberry  Hodder  we  haa  befo« 
u,  the  higheet  type  of  the  cultivated  «"8l»h  .^g»-  Jn 
Henry  H  Wright  we  «.w  the  in«m.t.on  of  fa.thful  devo 
UoTJl  duty-too  faithful,  we  thought,  aa  we  trudged^P^ 
the  eight  o'clock  lecture  in  the  mommg.    In  W  T  Atoa. 
.  practic.1  eurgeon  of  remarkable  akiU  .nd  an  .deal  te^to 
,„r  the  gener.l  pr.ctitioner.    How  we  «"f«f  '^J^ 
UAted  in  the  anatomical  demonstrations  of  Dr.  B.ch.rd 
^"those  infective  enthusiasm  did  much  ^  make  ans. 
Zy  the  favourite  subject  among  the  students.     I  W 
Tdouble  advantage  of  attending  the  last  course  "fD. 
Orfen  and  the  first  of  Dr.  Thorbum  on  mater.,  medrca  and 
?hC  "ties.    And  Dr.  Oldright  had  just  begun  h«  career 
„1  unselfish  devotion  to  the  cause  of  hyg.ene. 

To  one  of  my  teachers  I  must  pay  m  pass.ng  the  tobute 
of  M. flection.    There  .re  men  here  to^ay  who  feel  « 
I  do  about  Dr.  James  BoveU-that  he  was  of  those  finer 
Ltts  not  uncommon  in  Ufe.  touched  to  finer  .ssues  only 
Ta  ile  environment.    Would  t1    Paul  of  evo  ut.on 
S.ve  been  Thomas  Henry  Huxley  had  the  Senate  e  «*d 
r  young  n.tur.liBt  to  a  chair  m  this  umve^ty  m  1851! 
ol  r^of  a  cert«n  metal  rise  superior  to  then:  surrom.d- 
w'  Swhile  Dr.  BoveU  bad  that  aU-important  co-bm.- 


THE  MA8TER.W0RD  IN  MEDICINE 

tion  of  boundless  ambition  with  energy  and  induitry,  he 
had  that  fatal  fault  of  iiffusenew.  in  which  even  geniua  i» 
strangled.    With  a  quadrilateral  mind,  which  he  kept  spin- 
ning like  a  teetotum,  one  side  was  .'ever  kept  uppermost 
for  long  at  a  time.    Caught  in  a  storm  which  shook  the 
scientific  world  with  the  pubUcation  of  the  Origin  of  Species, 
instead  of  sailing  before  the  wind,  even  were  it  with  bare 
poles,  he  put  about  and  sought  a  harbour  of  refuge  m  wi.t- 
ing  a  work  on  Natural  Theology,  which  you  wU'  '^nd  on  the 
shelves  of  second-hand  book  shops  m  a  company  made  re- 
spectable  at  least  by  the  presence  of  Paley.    He  was  an 
omnivorous  reader  and  transmutor,  he  could  talk  plea- 
santly, even  at  times  transcendentaUy,  upon  anything  m 
the  science  of  the  day,  from  protoplasm  to  evolution ;  but 
he  lacked  concentration  and  that  scientific  accuracy  which 
only  comes  with  a  long  training  (sometimes,  mdeed,  never 
comes,)  and  which  is  the  ballast  of  the  boat.    But  the  bent 
of  his  mind  was  devotional,  and  early  swept  mto  the  Trac- 
tarian  movement,  he  became  an  advanced  Churchman,  a 
good  Anglican  Catholic.    As  he  chaffingly  remarked  one 
day  to  his  friend,  the  Rev.  Mr.  Darlmg,  he  was  like  the 
waterman  in  Pilgrim's  Progress,  rowing  one  way  towards 
Rome,  but  loo^'bg  steadfastly  m  the  other  direction  to- 
wards Lambeth.     His  Steps  to  the  Altar  and  his  Lectures 
on  the  Advent  attest  the  earnestness  of  his  convictions ; 
and    later  in    life,   foUowing    the  example  of  Linacre, 
he  took  orders  and  became  another  illustration  of  what 
Cotton  Mather  caUs  the  angelic  conjunction  of  medicine 
with  divinity.    Then,  how  weU  I  recaU  the  keen  love  with 
which  he  would  engage  in  metaphysical  discussions,  and 
the  ardour  with  which  he  studied  Kant,  Hamilton.  Reed,  and 

370 


THE  MASTER.WORD  IN  MEDiaNE 

Mill.  At  that  day,  to  the  Rev.  Prof.  Bevan  was  intrusted 
the  rare  privilege  of  directing  the  minds  of  the  thinking 
youths  at  the  Provincial  University  into  proper  philoso- 
phical channels.  It  was  rumoured  that  the  hungry  sheep 
looked  up  and  were  not  fed.  I  thought  so  at  least,  for  cer- 
tain of  them,  led  by  T.  Wesley  MiUs,  came  over  daily  after 
Dr.  BovcU'a  four  o'clock  lecture  to  reason  high  and  long 

v.ith  him 

On  Providence.  Foreknowledge.  Will  and  Fate. 
Fixed  Fate.  Freewill.  Foreknowledge  absolute. 

Yet  withal,  his  main  business  in  life  was  as  a  physician, 
imch  sought  after  for  his  skill  in  diagnosis,  and  much  be- 
loved for  his  loving  heart.    He  had  been  brought  uj)  'n  the 
very  best  practical  schools.    A  pupil  of  Bright  and  of  Ad- 
dison, a  warm  personal  friend  of  Stokes  and  of  Graves,  he 
maintained  loyally  the  traditions  of  Guy's,  and  taught  us 
to  X  ^  V erence  his  great  masters.    As  a  teacher  he  had  grasped 
the  f.  idamental  truth  announced  by  John  Hunter  of  the 
unity  of  physiolog'cal  and  pathological  processes,  and,  as 
became  the  occupant  of  the  chair  of  the  Institutes  of  Medi- 
cine, he  would  discourse  on  pathological  processes  in  lec- 
tures on  physiology,  and  illustrate  the    physiology  of 
bioplasm  in  lectures  on  the  pathology  of  tumours  to  the 
bewilderment  of  the  students.    When  in  September,  1870, 
he  wrote  to  me  that  he  did  not  intend  to  return  from  the 
West  Indies  I  felt  that  I  had  lost  a  father  and  a  friend  ;  but 
in  Robert  Palmer  Howard,  of  Montreal,  I  found  a  noble 
step-father,  and  to  these  two  men,  and  to  my  first  teacher, 
the  Rev.  W.  A.  Johnson,  of  Weston,  I  owe  my  success  in 
life—if  success  means  getting  what  you  want  and  bemg 

satisfied  with  it. 

371 


THE  MASTER-WORD  IN   MEDICINE 

n 

01  the  value  of  an  introductory  lecture  I  am  not  alto- 
gether certain.    I  do  not  remember  to  have  derived  any 
enduring  benefit  from  the  many  that  I  have  been  caUed 
upon  to  hear,  or  from  the  not  a  few  that  I  have  m&cted  .n 
my  day.    On  the  whole.  I  am  in  favour  of  abohshmg  the 
old  custom,  but  as  tv>i8  is  a  very  special  occasion,  with 
special  addresses.  I  consider -myself  most  happy  to  have 
been  selected  for  this  part  of  th.^  programme.    To  the  audi- 
ence  at  large  I  fear  that  what  I  have  to  say  wiU  appear  trite 
and  commonplace,  but  bear  with  me.  since,  indeed,  to  most 
of  you  how  good  soever  the  word,  the  season  is  long  past  m 
which  it  CMidd  be  spoken  to  your  edification.    As  I  glance 
fron  L.    -o  face  the  most  striking  smgle  peculiarity  is  the 
extraordmary  diversity  that  exists  among  you.    Alike  in 
that  you  are  men  and  white,  you  are  unlike  in  your  fea- 
tures.  very  unlike  in  your  minds  and  in  your  mental  tram- 
ing  and  your  teachers  wUl  mourn  the  singular  mequalities 
m  your  capacities.    And  so  it  is  sad  to  think  will  be  your, 
careers ;  for  one  success,  for  another  failure  ;  one  will  tread 
the  primrose  path  to  the  great  bonfire,  another  the  straight 
and  narrow  way  to  renown  ;  some  of  the  best  of  you  will  be 
stricken  early  on  the  road,  and  will  join  that  noble  band  of 
youthful  martyrs  who  loved  not  their  lives  to  the  death ; 
others,  perhaps  the  most  briUiant  among  you,  like  my  old 
friend  and  comrade,  Dick  Zimmerman  (how  he  would  have 
rejoiced  to  see  this  day  !).  the  Fates  will  overtake  and  wlml 
to  destruction  just  as  success  seems  assured.    When  the 
iniquity  of  obUvion  has  blindly  scattered  her  poppy  over 
us.  some  of  you  wiU  be  the  trusted  counseUors  of  this  com- 

872 


i'.il'v' 


THE  MASTER-WORD  IN  MEDICTNE 
munity,  ;  ad  the  heads  of  departments  of  this  Faculty ; 
while   for  the   large  majority  of   you,   let  us  hope,  is 
reserved  the  happiest  and  most  useful  lot  given  to  man 
-to  become  vigorous,  whole-souled,   inteUigent,  general 

practitioners. 

It  seems  a  bounden  duty  on  such  an  occasion  to  be  honest 
and  frank,  so  I  propose  to  teU  you  the  secret  of  Ufe  as  I  liave 
seen  the  game  played,  and  as  I  nave  tried  to  play  it  myself. 
You  remember  in  ou.  ^f  the  Jur  ^  «»tories  that  when 
Mowgli  wished  to  be  avenged  on  tht     ilagers  he  could  only 
get  the  help  of  Hathi  and  his  r  ons  by  sending  them  the 
master-word.    Thi-  I  propc'.^  to  give  you  in  the  hope,  yes, 
in  the  full  assuran      that  sour  of  you  at  least  wUl  lay  hold 
upon  it  to  your  profit.    Though  a  Uttle  one,  the  master- 
word  looms  large  in  meaning.    It  is  the  open  sesame  to 
every  portal,  the  great  equalizer  m  the  world,  the  true  phUo- 
sopher's  stone,  which  transmutes  aU  the  bat»e  metal  of  hu- 
manity into  gold.    The  stupid  man  among  you  it  wUl  make 
bright,  the  bright  man  brilliant,  and  the  brilliant  student 
steady.    With  the  magic  word  in  your  heart  all  things  are 
possible,  and  without  it  a"  study  is  vanity  and  vexation. 
The  miracles  of  Ufe  are  with  it ;  the  blind  see  by  touch,  the 
deaf  hear  with  eyes,  the  dumb  speak  with  fingers.    To  the 
youth  it  brings  hope,  to  the  middle-aged  confidence,  to  the 
aged  repose.    True  balm  of  hurt  minds,  in  its  presence  the 
heart  of  the  sorrowful  is  lightened  and  consoled.    It  is  di- 
rectly responsible  for  all  advances  in  medicine  durmg  the 
past  twenty-five  centuries.    Laying  hold  upon  it  Hippo- 
crates made  observation  ana  science  the  warp  and  woof  of 
our  art.    Galen  so  read  its  meaning  that  fifteen  centuries 
stopped  thinking,  end  slept  until  awakened  by  the  De  Pa- 

s.d 


THE  MASTER-WORD  IN  MEDICINE 
hrica  of  VesaUus,  which  is  the  very  incarnation  of  the 
master-word.    With  its  inspiration  Harvey  gave  an  im- 
Ddse  to  a  larger  circulation  than  he  wot  of.  an  unpulse 
which  we  feel  to-day.     Hunter  sounded  all  its  heights  and 
depths,  and  stands  out  in  our  history  as  one  of  the  great 
exemplars  of  its  virtue.    With  it  Virchow  smote  the  rock, 
and  the  waters  of  progress  gushed  out ;  whUe  in  the  hands 
of  Pasteur  it  proved  a  very  talisman  to  open  to  us  a  new 
heaven  in  medicine  and  a  ne^arth  in  surgery.    Not  only 
has  it  been  the  touchstone  of  progress,  but  it  is  the  measure 
of  success  in  every-day  Ufe.    Not  a  man  before  you  but  is 
beholden  to  it  for  his  position  here,  while  he  who  addresses 
you  has  that  honour  directly  in  consequence  of  havmg  had 
it  graven  on  his  heart  when  he  was  as  you  are  to-day.    i^d 
the  master-word  is  Work,  a  Uttle  one,  as  I  have  said,  but 
fraught  with  momentous  sequences  if  you  can  but  write  it 
on  the  tablets  of  your  hearts,  and  bind  it  upon  your  fore- 
heads.   But  there  is  a  serious  difficulty  in  getting  you  to 
understand  the  paramount  importance  of  the  work-habit 
as  part  of  your  organization.    You  are  not  far  from  the 
Tom  Sawyer  stage  with  its  phUosophy  "  that  work  consists 
of  whatever  a  body  is  obliged  to  do."  and  that  play  con- 
sists  of  whatever  a  body  is  not  obliged  to  do." 

A  great  many  hard  things  may  be  said  of  the  work-habit: 
For  most  of  us  it  means  a  hard  battle ;  the  few  take  to  it 
naturaUy  ;  the  many  prefer  idleness  and  never  learn  to  love 
labour.  Listen  to  this :  "  Look  at  one  of  your  industrious 
fellows  for  a  moment,  I  beseech  you,"  says  Robert  Loms 
Stevenson.  "  He  sows  hurry  and  reaps  indigestion ;  he 
puts  a  vast  deal  of  activity  out  to  interest,  and  receives  a 
larae  measure  of  nervous  derangement -iu  return;  Either 
*  874 


i 


THE  MASTERWORD  IN  MEDICINB 

he  absentB  himself  entirely  from  aU  feUowship,  "^d  Uve.  a 
recluse  in  a  garret,  with  carpet  sUppen  and  a  leaden  mkpot. 

or  he  comes  among  people  swiftly  and  bitterly  m  a ^n- 
traction  of  hb  whole  nervous  system,  to  discharge  some 
temper  before  he  returns  to  work.    I  do  not  care  how  much 
or  how  weU  he  works,  this  feUow  is  an  evil  feature  m  other 
people's  Uves."      ITiese  are  the  sentiments  of  an  over- 
^rked.  dejected  man ;  let  me  quote  the  motto  of  his  saner 
moments :  "  To  travel  hopefully  is  better  than  to  arrive 
and  the  teue  success  is  in  labour."    If  you  wish  to  learn  of 
the  miseries  of  scholars  in  order  to  avoid  them  read  Part  I. 
Section  2.  Member  3.  Subsection  XV.  of  that  immortal 
work,  the  AnMomy  of  MdancMy ;  but  I  am  here  to  warn 
you  against  these  evils,  and  to  entreat  you  to  form  good 
habits  in  your  student  days.  ,    ,.    * 

At  the  outset  appreciate  clearly  the  amis  and  obj^ts 
each  one  of  you  should  have  in  view-a  know  edge  of  dis- 
ease and  its  cure,  and  a  knowledge  of  yourself.    The  one, 
special  education,  will  make  you  a  practitioner  of  m*di. 
cine ;  the  other,  an  imier  education,  may  make  you  a  truly 
good  man,  four  square  and  without  a  flaw.    The  one  is  ex- 
Lsic  and  is  largely  accomplished  by  teacher  and  tutor, 
by  text  and  by  tongue ;  the  other  is  intnnsic  and  is  the 
mental  salvation  to  be  wrought  out  by  each  one  for  himself. 
The  first  may  be  had  without  the  second ;  any  one  of  you 
may  become  an  active  practitioner,  without  ever  havmg 
had  sense  enough  to  realize  that  through  Ufe  you  ^ve  been 

a  fool ;  or  you  may  have  the  second  without  the  first  and, 
without  knowing  much  of  the  art.  you  may  have  the  en- 
dowments of  head  and  heart  that  "^^ke  the^^^f /^^  ^ 
possess  go  very  far  in  the  community.  With  what  I  hop. 
*^  876 


«1 


THE  MASTER-WORD  IN  MEDICINE 
to  infect  yoa  is  a  desire  to  have  a  due  proportion  of  each. 
So  far  as  your  professional  education  is  concerned,  what  I 
shall  say  may  make  for  each  one  of  you  an  easy  path  easier. 
The  multiplicity  of  the  subjects  to  be  studied  is  a  difficulty, 
and  it  is  hard  for  teacher  and  student  to  get  a  due  sense  of 
proportion  in  the  work.    We  are  in  a  transition  stage  in 
our  methods  of  teachings,  and  have  not  everywhere  got 
away  from  the  idea  of  the  examination  as  the  "  be-all  and 
end-all ; "  so  that  the  student  has  constantly  before  his 
eyes  the  magical  letters  of  the^ degree  he  seeks.    And  this 
is  well,  perhaps,  if  you  will  remember  that  having,  m  the 
old  phrase,  commenced  Bachelor  of  Medicine,  you  have 
only  reached  a  point  from  which  you  can  begin  a  Ufe-long 
process  of  education. 

So  many  and  varied  are  the  aspects  presented  by  this 
theme  that  I  can  only  lay  stress  upon  .  few  of  the  more  es- 
sential.   The  very  first  step  towards  success  in  any  occupa- 
tion is  to  become  interested  in  it.    Locke  put  this  in  a  very 
happy  way  when  he  said,  give  a  pupU  "  a  relish  of  know- 
ledge "  and  you  put  life  into  his  work.    And  there  is  no- 
thing more  certain  than  that  you  cannot  study  well  if  you 
are  not  interested  in  your  profession.    Your  presence  here 
b  a  warrant  that  in  some  way  you  have  become  attracted 
to  the  study  of  medicine,  but  the  speculative  possibilities 
so  warmly  cherished  at  the  outset  are  apt  to  cool  when  in 
contact  with  the  stem  realities  of  the  class-room.    Most  of 
you  have  already  experienced  the  all-absorbing  attraction 
of  the  scientific   branches,  and  nowadays  the   practical 
method  of  presentation  has  given  a  zest  which  was  usuaUy 
lacking  in  the  old  theoretical  teaching.    The  Ufe  has  be- 
come more  serious  in  consequence,  and  medica.  students 

3Tu 


THE  MASTER-WORD  IN  MEDICINE 

have  put  away  many  of  the  chUdish  tricks  with  which  we 
used  to  keep  up  their  bad  name.    Compare  the  picture  of 
the  "  sawbones  "  of  1842.  as  given  in  the  recent  biography 
of  Sir  Henry  Acland,  with  the  representatives  to-day,  and 
it  is  evident  a  great  revolution  has  been  effected,  and  very 
largely  by  the  salutary  influences  of  improved  methods  ol 
education.    It  is  possible  now  to  fill  out  a  day  with  prac- 
tical work,  varied  enough  to  prevent  monotony,  and  so 
arranged  that  the  knowledge  b  picked  out  by  the  student 
himsdf ,  and  not  thrust  into  him,  willy-nilly,  at  the  pomt  of 
the  tongue.    He  exercises  his  wits  and  is  no  longer  a  pas- 
sive Strasbourg  goose,  tied  up  and  stuffed  to  repletion. 

How  can  you  take  the  greatest  possible  aovantage  of 
your  capacities  with  the  least  possible  strain?  By  culti- 
vating system.    I  say  cultivating  advisedly,  smce  some  of 
vou  will  find  the  acquisition  of  systematic  habits  very  hard. 
There  are  minds  congenitally  systematic ;  others  have  a 
Ufe-long  fight  against  an  inherited  tendency  to  diffuseness 
and  carelessness  in  work.    A  few  brilliant  feUows  try  to 
dispense  with  it  altogether,  but  they  are  a  burden  to  their 
brethren  and  a  sore  trial  to  their  intimates.    I  have  heard 
it  remarked  that  order  is  the  badge  of  an  ordinary  mmd. 
So  it  may  be.  but  as  practitioners  of  medicine  we  have  to  be 
thankful  to  get  into  that   useful  class.    Let  me  entreat 
those  of  you  who  are  here  for  the  first  time  to  lay  to  heart 
what  I  say  on  this  matter.    Forget  all  else,  but  take  away 
this  comisel  of  a  man  who  has  had  to  fight  a  hard  battle, 
and  not  always  a  successful  one,  for  the  Uttle  order  he  has 
had  in  his  life ;  take  away  with  you  a  profound  conviction 
of  the  value  of  system  in  your  work.    1  appeal  to  the  fresh- 
men especiaUy,  because  you  to-day  make  a  begimung.  and 

377 


[ 


THE  MASTER  WORD  IN  MEDICINE 

your  future  career  depends  very  mucli  upon  the  habits  you 
wiU  form  during  this  session.    To  foUow  the  routine  of  the 
classes  is  easy  enough,  but  to  take  routme  ^n^  eve^  1*^ 
of  your  daily  Ufe  is  a  hard  task.    Some  of  you  wiU  start  out 
io4illy  as  did  Christian  and  Hopeful,  and  for  many  days 
wmToarney  safely  towards  the  Delectable   Mountams. 
dreaming  of  them  and  not  thinking  of  disaster  untU  you 
find  yo^lves  m  the  strong  captivity  of  Doubt  and  under 
the  grinding  tyram^y  of  Despair.    You  ^^^  ^^^« 
confident.    Begm  again  and  more  cautiously.    No  student 
escapes  whoUy  from  these  perils  and  trials;  be  not  dis- 
riSIned.e^ctthem.    Let  each  hour  of  the  dayj^ve 
its  allotted  duty,  and  cultivate  that  power  of  concentratu,n 
which  grows  with  its  exercise,  so  that  the  attention  neither 
flags  nor  wavers,  but  settles  with  a  bull-dog  tenacity  on 
Z  subject  before  you.    Constant  repetition  makes  a  good 
habit  fil  easUy  in  yo.ir  mind,  and  by  the  end  of  the^^ 
you  may  have  gained  that  most  precious  of  all  ^^o^^^- 
the  power  to  work.    Do  not  underestimate  the  <^fficu^^ 
you  will  have  in  wringing  from  your  reluctant  selves  the 
stem  determination  to  exact  the  uttermost  mmute  on  your 
schedule.    Do  not  get  too  interested  in  one  ^^dy  at  the 
expense  of  another,  but  so  map  out  your  day  that  due  al- 
lowance is  given  to  each.    Only  in  this  way  can  the  average 
student  get  the  best  that  he  can  out  of  his  capacities     And 
it  is  worth  aU  the  pains  and  trouble  he  can  possib^  take 
for  the  ultimate  gain-if  he  can  reach  his  doctorate  with 
system  so  ingrained  ohat  it  has  becorr    an  mtegral  part  of 
lis  being.     The  artistic  sense  of  perfection  mj°^k^ 
another  much-to-be-desired  quaUty  to  be  cultivated.     No 
matter  how  trifling  the  matter  on  hand,  do  it  with  a  feelmg 

878 


THE  MASTER-WORD  IN  MEDICINB 
that  it ''-  -lands  the  best  that  '^  in  you,  and  when  done  look 
it  ovex  vnth  a  critical  eye,  no-  sparing  a  strict  judgment  of 
vouraelf    This  it  is  that  makes  anatomy  a  student  b  touch- 
stone     Take  the  man  who  does  his  "  part "  to  perfection, 
who  has  got  out  aU  there  is  in  it,  who  labours  over  the  oags 
of  connective  tissue  and  who  demonstrates  Meckel  s  gan- 
bUou  in  his  part-this  is  the  feUow  in  after  years  who  is  apt 
in  emergencies,  who  saves  a  leg  badly  smashed  in  a  railway 
accident,  or  fights  out  to  the  finish,  never  knowing  when  he 
is  beaten,  in  a  case  of  typhoid  fever. 

Learn  to  love  the  freedom  of  the  student  hfe.  only  too 
quickly  to  pass  awav ;  the  absence  o!  the  coarser  cart,  of 
after  days,  the  joy  in  comradeship,  the  deUght  in  new  work, 
the  happmess  in  knowing  that  you  are  makmg  progress. 
Once  o\dy  can  you  enjoy  these  pleasures.    The  seclusion 
of  the  student  Ufe  is  not  always  good  for  a  man,  particularly 
for  those  of  you  who  will  afterwards  engage  in  general }      • 
tice,  since  you  will  miss  that  faciUty  of  intercourse  x.     a 
which  often  the  doctor's  success  depends.    On  t^'^e  ^^her 
hand  sequestration  is  essential  for  those  of  you  with  high 
ambitions  proportionate  to  your  capacity.    It  was  for  such 
that  St.  Chrysostom  gave  his  famous  couniel.     Depart 
from  the  highways  and  transplant  thyself  into  some  en- 
closed  gromid.  for  it  is  hard  for  a  tree  that  stends  by  the 
wav8id3  to  keep  its  frait  till  it  be  rve." 

H^s  work  no  dangers  comiected  with  it?  What  of  this 
bogie  of  overwork  of  which  we  hear  so  much  ?  There  a« 
dangers,  but  they  may  readily  be  avoided  with  a  litt  e  care^ 
I  can  only  mention  two,  one  physical,  one  mental  The 
very  best  students  are  often  not  the  strongest.  Ill-health 
the  bridle  of  Theages,  as  Plato  called  it  in  the  case  of  one  of 

379 


THE  MASTER-WORD  IN  MEDICINE 
hiB  friendfl  whose  mind  ha  1  thriven  at  the  expend  oi  his 
body  may  have  been  the  diverting  influence  towards  booto 
or  the  profession.     Among  the  good  men  who  have  studied 
with  me  there  stands  out  in  my  remembrance  many  a  yomig 
Lycidas.  "  dead  ere  his  prime."  sacrificed  to  carelessness  m 
habits  of  Uvmg  and  neglect  of  ordinary  sanitary  ^ws.    M^ 
dical  students  are  much  exposed  to  infection  of  all  sorts  to 
combat  which  the  body  must  be  kept  in  first-class  cona- 
tion.   Grossteste.  the  great  bishop  of  Lincob,  remarked 
that  there  were  three  things  necessary  for  temporal  salva- 
tion-food, sleep  and  a  cheerful  disposition.    AddtothMe 
suitable  exercise  and  you  have  the  means  by  which  good 
health  may  be  maintained.    Not  that  health  is  to  be  a 
matter  of  perpetual  soUcitation,  but  habits  which  favour 
the  corpus  sanum  foster  the  mma  sana,  in  which  the  joy  ot 
Uving  and  the  joy  of  working  are  blended  in  one  harmony 
Let  me  read  you  a  quotation  from  old  Burton,  the  great 
authority  on  morbi  ervdUorum.    There  are  "  many  reasons 
why  students  dote  more  often  than  others.    The  first  la 
their  negligence ;  other  men  look  to  their  tools,  a  pamter 
will  wash  his  pencils,  a  smith  will  look  to  his  hammer,  anvil, 
forge ;  a  husbandman  will  mend  his  plough-irons,  and 
orind  his  hatchet,  if  it  be  dull ;  a  falconer  or  huntsman  will 
have  an  especial  care  of  his  hawks,  hounds,  hrrses.  do^. 
etc  •  a  musician  will  string  and  unstring  his  lute.  ete. ;  only 
scholars  neglect  that  instrument,  their  brain  and  spirits  (1 
mean)  which  they  daUy  use."  '  .  *  ^i. 

Much  study  is  not  only  beUeved  to  be  a  weariness  of  the 
flesh,  but  also  an  active  cause  of  Ul-health  of  mmd,  m  aU 
grades  and  phases.    I  deny  that  work,  legitimate  work, 
»  Quotation  msonly  from  Marailiua  Ficinua. 
380 


THE  MASTER-WORD  IN  MEDICINE 

has  anything  to  do  with  this.  It  is  that  foul  fiend  Worry 
who  is  responsible  for  a  large  majority  of  the  cases.  The 
more  carefully  one  looks  into  the  causes  of  nervous  break- 
down m  studento,  the  less  important  is  work  P^-  '«  »  » 
factor.  There  are  a  few  cases  of  genuine  overwork,  but 
they  are  not  common.  Of  the  causes  of  worry  in  the  stu- 
dent life  there  are  three  of  prime  importance  to  which  1 
may  briefly  refer. 

An  anticipatory  attitude  of  mind,  a  perpetual  forecast- 
b-  disturbs  the  even  tenor  of  his  way  and  leads  to  disaster. 
Years  ago  a  sentence  m  one  of  Carlyle's  essays  made  a  last- 
ing impression  on  me :  "  Our  duty  is  not  to  see  what  lies 
dimly  at  a  distance,  but  to  do  what  lies  clearly  at  baud.      I 
have  long  mainteaied  that  the  best  motto  for  a  student  is. 
"  Take  no  thought  for  the  monow."    Let  the  uay  s  work 
suffice ;  live  for  it.  regardless  of  what  the  future  has  m 
store.  beUeving  tha.  to-morrow  should  take  thought  for  the 
things  of  itself.    There  is  no  such  safeguard  against  the 
morbid  apprehensions  about  the  futme.  the  dread  of  ex- 
aminations and  the  doubt  of  the  ultimate,  success.    Nor  is 
there  any  risk  that  such  an  attitude  may  breed  careless- 
ness     On  the  contrary,  the  absorption  m  the  duty  of  the 
hour  is  in  itself  the  best  guarantee  of  ultimate  success.  "  He 
that  observeth  the  wind  shaH  not  sow.  and  he  that  regard- 
eth  the  clouds  shaU  not  reap,"  which  means  you  camiot 
work  profitably  with  your  mind  set  upon  the  future. 

Another  potent  cause  of  worry  is  an  idolatry  by  which 
many  of  you  will  be  sore  let  and  hindered.  The  mistress  of 
your  studies  should  be  the  heavenly  Aphrodite,  the  mother- 
less daughter  of  Uranus.  Give  her  your  whole  heait,  and 
she  will  be  your  protectress  and  friend.    A  jealous  creature, 

881 


i 


THE  MASTER-WORD  IN  MEDICINE 
brooking  no  second.  U  sle  finds  you  trifling  and  coquetting 
with  her  rival,  the  younger,  earthly  Aphrodite,  daughter  of 
Zeus  and  Dione.  she  will  whistle  you  off  and  let  you  down 
the  wind  to  be  a  prey,  perhaps  to  the  examiners,  certainly 
to  the  worm  regret.    In  plainer  language,  nut  youi  affec- 
tions in  cold  storage  for  a  few  years,  and  you  wiU  take  them 
out  ripened,  perhaps  a  bit  meUow,  but  certamly  less  subject 
to  tho^  frequent  changes  which  perplex  so  many  young 
men.    Only  a  grand  pas8ion,-an  ill-absorbing  devotion  to 
the  elder  goddess  can  save  the  man  with  a  congemtal  ten- 
dency  to  philandering,  the  flighty  Lydgate  whospoi^  with 
Celia  and  Dorothea,  and  upon  whom  the  judgment  ulti- 
mately falls  in  a  basU-plant  of  a  wife  like  Rosamond. 

And  thirdly,  one  and  all  of  you  will  have  to  face  the  or- 
deal  of  every  student  in  this  generation  who  sooner  or  later 
tries  to  mix  the  waters  of  science  with  the  oU  of  faith.    You 
can  have  a  great  deal  of  both  if  you  only  keep  them  se- 
parate.    The  worry  comes  from  the  attempt  at  mixture. 
As  general  practitioners  you  will  need  aU  the  faith  you  can 
carry,  and  while  it  may  not  a!  vays  be  of  the  c  nventional 
pattern,  when  expressed  in  your  lives  rather  than  on  yoi^ 
lips,  the  variety  is  not  a  bad  one  from  the  standpomt  of  St 
James ;  and  may  help  to  counteract  the  common  scandal 
aUuded  to  in  the  celebrated  diary  of  that  gossipy  old  pastor- 
doctor,  the  Rev.  John  Ward :  "  One  told  the  Bishop  of 
Gloucester  that  he  imagined  physitians  of  all  other  men  the 
most  competent  judges  of  all  other  affairs  of  religion-and 
his  reason  was  because  they  were  wholly  unconcerned  with 
it." 

ni 

Professional  woriL  of  any  sort  tends  to  narrow  the  mmd, 


THE  MASTER-WORD  IN  MEDICTNE 

to  limit  the  point  of  vie^  and  to  put  a  hall-mark  on  a  man 
of  a  moat  unmistakable  kind.    On  the  one  hand  are  the 
intense,  ardent  natures,  absorbed  in  their  studies  and 
quickly  losing  interest  m  everything  but  their  profession, 
while  other  faculties  and  interests  "  fust "  unsued.     On 
the  other  hand  are  the  bovine  brethren,  who  think  of  no- 
thing but  the  treadmill  and  the  com.    From  very  different 
causes,  the  one  from  concentration,  the  other  from  apathy, 
both  are  apt  to  neglect  those  outside  studies  that  widen  the 
sympathies  and  help  a  man  to  get  the  best  there  is  out  of 
life.    Like  art,  medicine  is  an  exacting  mistress,  and  m  the 
pursui';  oi  one  of  the  scientific  branches,  sometimes,  too,  in 
practice,  not  a  portion  of  a  man's  spirit  may  be  left  free  for 
other  distractions,  but  this  does  not  often  happen.    On 
account  of  the  intimate  personal  nature  of  hia  work,  the 
medical  man,  perhaps  more  than  any  other  man,  needs  that 
higher  education  of  which  Plato  speaks,—"  that  education 
m  virtue  from  youth  upwards,  which  enables  a.  man  eagerly 
to  pursue  the  ideal  perfection."    It  is  not  for  all,  nor  can 
all  attain  to  it,  but  there  is  comfort  and  help  in  the  pursuit, 
even  though  the  end  is  never  reached.    For  a  large  ma- 
jority th3  daily  round  and  the  common  task  furnish  more 
than  enough  to  satisfy  their  heart's  desire,  and  there  seems 
no  room  left  for  anything  else.    Like  the  good,  easy  man 
whom  MUton  scores  in  the  AreopagUica,  whose  reUgion  was 
a  "  traffic  so  entangled  that  of  aU  mysteries  he  could  not 
skill  to  keep  a  stock  going  upon  that  trade  "  and  handed  it 
over  with  all  the  locks  and  keys  to  "  a  divine  of  note  and 
estimation,"  so  it  is  with  many  of  us  in  the  matter  of  this 
higher  education.    No  longer  intrinsic,  wrought  in  us  and 
ingrained,  it  has  become,  in  Milton  phrase,  a  "  dividual 

383 


THE  MASTER-WORD  IN  BfEDICINE 
„,ovable."  h^ded  over  now^Uy  to  the  djuly  pre- or  to 
the  haphiuard  inBtruction  oi  the  pulpit,  the  pUt  onn  ^ 
the  miiaanes.    Like  a  good  many  other  things,  it  oom^ 
b  a^r  and  more  enduring  fom  H  not  too  c^nsciotu^y 

sought.  The  aU-important  thing  is  to  get  a  rebsh  for  the 
aZ  company  of  the  race  m  a  daUy  intercourse  with  some 
Jmegr^  minds  of  aU  ages.    Now.  in  the  spnng-timeof 

life  pick  your  intimates  among  them,  and  begm  a  systema- 
liie,  picK  yo  will  need  a 

tic  cultivation  of  their  worifs.    «»"7       / 
strong  leaven  to  raise  you  above  the  dough  m  which  itjnU 
be  y7ur  lot  to  labour.    Uncongenial  sunoundmgs.  an  evw- 
pr^ent  dissonance  between  the  aspirations  within  and  the 
actuaries  without,  the  oppressive  discords  of  hui^n  so- 
ciety, the  bitter  tragedies  of  Ufe,  the  lacrym<u^  rerum,h^ 
Bides  the  hidden  springs  of  which  we  sit  m  sad  despair"^ 
these  tend  to  foster  in  some  natures  a  cymcism  quite  foreign 
to  our  vocation,  and  to  which  this  imier  education  offeni 
the  best  antidote.    Personal  contect  with  men  of  high  pur- 
pose  and  character  will  help  a  man  to  make  a  stert-to 
Ce  the  desire,  at  least,  but  in  its  ^^'^^^'Z:^ 
that  word  best  expresses  it-has  to  be  wrought  out  by  ea^ 
one  for  himself.    Stert  at  once  a  bed-side  library  and  s^nd 
the  last  half  hour  of  the  day  in  commumon  wxth  the  samte 
of  humanity.    There  are  great  lessons  to  be  learned  from 
JobandfromDavid.fromIsaiahandSt.Paul.    Taughtby 

Shakespeare  you  may  tak^y-,-^^f  ^vetpi"^ 
H^easure  with  singular  precision,  ^f  "^  f  J^°^^  J^^^Te 
and  Marcus  AureUus.    Should  you  be  so  fortunate  as  to  be 

bom  a  Platoniat.  Jowett  will  introduce  you  to  the  great 
bom  a  ria  .  ^^^^  j^^^l^^ 

master  through  whom  alone  we  can  vuu^ 

and  whose  perpetual  modermiess  stertles  and  deUghts. 

384 


THE  BIASTER-WORD   IN  MEDICINE 

Montaigne  will  teach  70a  moderation  m  all  things,  and  to 
be  "  seiJed  of  his  tribe  "  is  a  special  privilege.  We  have  in 
the  profession  only  a  few  great  literary  heroes  of  the  first 
rank,  the  friendship  and  counsel  of  two  of  whom  you  can- 
not too  earnestly  seek.  Sir  Thomas  Browne's  Rdigio 
Medici  should  be  your  pocket  companiou,  while  from  the 
Breakfast  Table  Series  of  Oliver  Wendell  Holmes  you  can 
glean  a  philosophy  of  life  peculiarly  suited  to  the  needs  of  a 
physician.  There  are  at  least  a  dozen  or  more  works  which 
would  be  helpful  in  getting  wisdom  in  life  which  only  comes 
to  those  who  earnestly  seek  it.  * 

A  conscientious  pursuit  of  Plato's  ideal  perfection  may 
teach  you  the  three  great  lessons  of  life.     You  may  learn  to 
consume  your  oum  smoke.    The  atmosphere  is  darkened  by 
the  murmurings  and  whimperings  of  men  and  women  over 
the  non-essentials,  the  trifles  that  are  inevitably  incident 
to  the  hurly  burly  of  the  day's  routine.    Things  cannot  al- 
ways go  your  way.    Learn  to  accept  in  silence  the  minor 
aggravations,  cultivate  the  gift  of  taciturnity  and  consume 
your  own  smoke  with  an  extra  draught  of  hard  work,  so 
that  those  about  you  may  not  be  annoyed  with  the  dust 
and  soot  of  your  complaints.    More  than  any  other  the 
practitioner  of  med    .        ay  illustrate  the  second  great 
lesson,  that  we  are  het^     4,  to  get  aR  we  can  out  of  lif'  for  our- 
sdves,  but  to  try  to  make  the  lives  of  others  happier.    This  is 
the  essence  of  that  oft-repeated  admoniti  )i\  of  Christ,  "  He 
that  findeth  his  life  shall  lose  it,  and  he  that  lo  seth  his  life 
for  my  sake  shall  find  it,"  on  which  hard  saying  if  the 
children  of  this  generation  would  only  lay  hold,  there  would 
be  less  misery  and  discontent  in  the  world.    It  is  not  pos- 

>  Note  p.  389  <"  Bedside  Library  for  Medical  Students." 
AE  385  c  c 


THB  MASTER-WORD  IN  MEDICINE 
.ible  to  anyone  to  h»  v  brtt«  opportuniti- to  U  v  ihk 
CnthM.^uwUl enjoy.    The  practice  ol  «^meu« 
^notatrLie;ao.mBg.notal«i«nc«;ac^^ 
yo«  he«t  wffl  be  exerci^d  equ-Uy  with  yonr  W^  Wt«^ 
L  beet  part  of  your  work  will  h.venotbvng  to  do  witt^ 

potion,  and  powder.,  but  with  the  exerciee  ol  an  mfluenoe 

Vi  th«  .troi^upon  the  weak,  of  th*  ^^^^-^^^^ 
wicked.ofihewi.euponthefooli.h.    To  you -the  ^ 
iamUy  ooun.6Uor.  the  father  wiU  come  with  hi.  an«eta-, 
tbe  mother  with  her  hidden  grief,  the  daughter  with  h« 
trial.,  and  the  «>n  with  hi.  foUie..    My  one-third  of  the 
work  you  do  will  be  entered  in  other  book,  than  yoia.. 
Courage  and  cheerfulnew  will  not  only  carry  you  over  the 
rough  places  of  life,  but  will  enable  you  to  bnng  comfort 
and  he4»  to  the  weak-hearted  and  will  con«,le  you  m  the 
Bad  hotm  when,  like  Unde  Toby,  you  have     to  whuitle 
that  you  may  not  weep."  ,    ^   /«ii 

And  the  third  lesson  you  may  learn  i.  the  hardest  of  ail- 
that  the  lau>  of  the  higher  life  is  <nUy  fulfUed  hflo^,^;^ 
charity.    Many  a  physician  whose  daUy  work  is  a  dady 
^und  of  beneficence  will  say  hard  things  and  think  hard 
thoughts  of  a  coUeague.    No  sin  wiU  so  easily  beset  you  a. 
unc^tableness  towards  your  brother  practitioner.    So 
strong  is  the  personal  element  in  the  practice  of  m^cme 
and^  many  are  the  wagging  tongues  in  every  parish,  that 
evil-speaking,  lying,  and  slandering  find  a  shming  mark 
in  the  kpses  and  mistakes  which  are  inevitable  m  our  woA. 
There  is  no  reason  for  discord  and  disagreement,  and  the 
only  way  to  avoid  trouble  is  to  have  two  plam  rules.    From 
the  day  you  begin  practice  never  under  any  circumstance, 
listen  to  a  tale  told  to  the  detriment  of  a  brother  pracU- 

886 


THE  MASTER-WORD  IN  MBDICINB 
tioner.    And  when  wy  dispute  or  troable  doM  ame.  go 
frankly,  «e  lun^t.  and  Ulk  the  matter  over,  in  which  way 
you  may  gam  a  brother  and  a  friend.    Very  eaey  to  c«^ 
out.  you  may  think !  Far  from  it ;  there  »  no  h«der  battle 
to  fight.    TheoretioaUy  thei.  seem,  to  be  no  difficulty,  but 
when  the  concrete  womid  is  rankling,  and  after  Mrs  Jones 
has  rubbed  in  the  cayenne  pepper  by  declaring  that  Dr.  J. 
told  her  m  confidence  of  your  shocking  bunghng.  your  at- 
titude  of  mind  is  that  you  wocid  rather  see  him  m  p^- 
tory  than  moke  advances  towr-ds  reconcihation.    Wait 
unta  the  day  of  your  trial  comu.  and  then  remember  my 

"'ltd  in  closing,  may  I  say  a  few  words  to  the  younger 
practitioners  in  the  audience  whose  activities  w^  wax  not 
wane  with  the  growing  years  of  the  centurr  which  opens  so 
auspiciously  for  this  school,  for  this  city,  and  for  oiu  coun- 
trv     You  enter  a  noble  heriUge.  made  so  by  no  efiorts  of 
your  own.  but  by  the  generations  of  men  who  have  unsel- 
Lhly  sought  to  do  the  best  they  could  for  suffenng  man- 
kind     Much  has  been  done,  much  remains  to  do ;  a  way 
has  been  opened,  and  to  the  possibUities  in  the  scientific 
development  of  medicine  there  seems  to    be  no  Umi  . 
Except  in  its  appUcation,  as  general  pxactitioners.  you  w^ 
nothavemuchtodo  with  this.    Yours  is  a  higher  and  more 
sacred  duty.    Think  not  to  light  a  light  to  shine  before  men 
that  they  may  see  your  good  works ;  contrariwise,  you  be- 
long  to  the  great  army  of  quiet  workers  physicians  and 
p^l.,  sisters  and  nurses.  aU  over  the  world,  the  membe« 
!f  whia  strive  not  neither  do  they  cry.  nor  are  then  voice 
heard  in  the  streets,  but  to  them  is  given  tbe  mmistxy  o 
consolation  in  sorrow,  need,  and  sickness.    Like  the  ideal 

887 


THE  MASTER-WORD  IN  MEDICINE 
wife  of  whom  Plutarch  speaks,  the  best  doctor  b  often  the 
one  of  whom  the  pubUc  hears  the  least ;  but  nowadays,  in 
the  fierce  light  that  beats  upon  the  hearth,  it  is  increasingly 
difficult  to  lead  the  secluded  Ufe  in  which  our  best  work  is 
done.    To  you  thesUent  workers  of  the  ranks,  in  villages 
and  country  districts,  in  the  slums  of  our  large  ci^.ea,  in  the 
mining  camps  and  factory  towns,  in  the  homes  of  the  rich, 
and  in  the  hovels  of  the  poor,  to  you  is  given  the  harder  task 
of  iUustrating  with  your  Uves  $he  Hippocratic  standards  of 
Learning,  of  Sagacity,  of  Humanity,  and  of  Probity.    Of 
learning,  that  you  may  apply  in  your  practice  the  best  that 
is  known  in  our  art,  and  that  with  the  mcrease  in  your 
knowledge  there  may  be  an  increase  in  that  priceless  en- 
dowment of  sagacity,  so  that  to  all,  everywhere,  skUled 
succour  may  come  in  the  hour  of  need.    Of  a  humanity,  that 
will  show  in  your  daily  life  tenderness  and  consideration  to 
the  weak,  infinite  pity  to  the  suffering,  and  broad  charity 
to  all.    Of  a  probity,  that  will  make  you  under  aU  circum- 
stances true  to  yourselves,  true  to  your  high  calling,  and 
true  to  your  fellow  man. 


!<>' 


388 


BED-SIDE  LIBRARY  FOR  MEDICAL  STUDENTS. 

A  LIBERAL  education  may  be  had  at  a  very  slight  cost  of  time 
and  money.  WeU  filled  though  the  day  be  with  appointed 
tasks,  to  make  the  best  possible  use  of  your  one  or  of  your 
ten  talents,  rest  not  satisfied  with  this  professional  training, 
but  try  to  get  the  education,  if  not  of  a  scholar,  at  least  of  a 
gentleman.  Before  going  to  sleep  read  for  half  an  hour,  and 
in  the  morning  have  a  book  open  on  your  dressing  table. 
You  will  be  surprised  to  find  how  much  can  be  accomplished 
in  the  course  of  a  year.  I  have  put  down  a  list  of  ten  books 
which  you  may  make  close  friends.  There  are  many  others ; 
studied  carefully  in  your  student  days  these  will  help  in  the 
inner  education  of  which  I  speak. 


I 

n. 
III. 

IV. 

V. 

VI. 

VII. 

VIII. 

IX. 

X. 


Old  and  New  Testament. 
Shakespeare. 
Montaigne.  * 
Plutarch's  Lives.  ^ 
Marcus  Aurelius. ' 
Epicteus.  > 
Rdigio  Medici. ' 
Don  Quixote. 
Emerson 
Oliver  Wendell  Hohnes— Breakfast-Table  Series. 

1  The  Temple  OaBeicB,  J.  M.  Dent  &  Co. 

'  Golden  Treasury  Series,  MacMillan  Company. 


Butltr  &  Tanner,  The  Selwood  Printing  Works,  Frome,  and  Losdoo. 

388 


